Preliminary Diagnosis: Liver Abscess

I. What imaging technique is first-line for this diagnosis

  • Plain radiograph of the chest and abdomen

II. Describe the advantages and disadvantages of this technique for diagnosis of a liver abscess.

Advantages
  • Highly portable
  • Relatively inexpensive imaging modality
Disadvantages
  • Less sensitive and specific in detecting and diagnosing a liver abscess or any liver pathology
  • Does not allow for exquisite visualization of the surrounding anatomic structures
  • Less adept in detailing the primary pathologic process and any secondary complications

III. What are the contraindications for the first-line imaging technique?

  • No specific contraindications to plain radiography exist.

IV. What alternative imaging techniques are available?

  • CT of the abdomen and pelvis with IV contrast
  • MR evaluation of the abdomen and pelvis
  • Ultrasound
  • Nuclear medicine tagged WBC scans

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of a liver abscess.

CT of the abdomen and pelvis with IV contrast
Advantages
  • Highly sensitive and specific in detecting, diagnosing, and characterizing a primary liver abscess and its extent
  • Highly adept in characterizing any secondary complication from a primary liver abscess
  • Helps guide treatment
Disadvantages
  • Exposes patients to ionizing radiation
MR evaluation of the abdomen and pelvis
Advantages
  • Does not expose patients to ionizing radiation
  • Highly sensitive and specific in detecting a primary hepatic abscess and characterizing any secondary complications
  • Offers exquisite imaging of the adjacent biliary system for any secondary complications
Disadvantages
  • Expensive
  • Time-consuming
  • Requires significant patient cooperation to minimize motion artifact
Ultrasound
Advantages
  • Highly portable
  • Relatively inexpensive imaging modality for evaluating liver pathology
  • Highly sensitive and specific imaging modality for diagnosing and characterizing a liver abscess
  • Helps guide treatment
  • Better evaluates the vascularity of a lesion than other imaging modalities
  • Does not expose patients to ionizing radiation
Disadvantages
  • Operator dependent
Nuclear medicine tagged WBC scans
Advantages
  • Highly specific for pyogenic abscesses
Disadvantages
  • Expensive
  • Limited in detailing surrounding anatomic structures
  • Limited in guiding treatment

VI. What are the contraindications for the alternative imaging techniques?

CT of the abdomen and pelvis with IV contrast
  • May be contraindicated in pregnant patients
MR evaluation of the abdomen and pelvis
  • Contraindicated in patients with non-MR compatible hardware.
Ultrasound
  • No specific contraindications exist.
Nuclear medicine tagged WBC scans
  • May be contraindicated in pregnant patients