الفهرس 
* IntroductionOnly 14 pages are availabe for public view
 |  | from | 90 |  |  |
| | | from | 90 | | |
Abstract
SUMMARY AND CONCLUSION Liver abscess was reported in the writings of Hippocrates, who based prognosis on the type of fluid recovered from the abscess.
Liver abscess is the most common type of visceral abscess, it is a potentially life-threatening disease, has undergone significant changes in epidemiology, management, and mortality over the past several decades.The human liver is the largest solid organ of the body. Radiologist should notice that position of the liver in the body is not static. The liver moves up and down with the diaphragm and rotates during respiration. It rotates backward when an individual lies down in the supine position.
Ultrasonography has the main role in diagnosis of liver abscess earlier than clinical diagnosis; liver abscess should be diagnosed early to decrease morbidity and mortality.
Early diagnosis offers the best chance of cure. Late diagnosis usually gives rise to very large cavities or multiple cavities which does not obliterate even after successful management and may persist for years and can get reinfected especially by haematogenous route.
Ultrasonographic role in diagnosis of liver abscess is not only imaging but also as guidance to take samples of its contents, the final choice of antibiotics should be guided by the results of a culture.
It also has main role in treatment, percutaneous drainage is always considered if the condition of the patient can not be improved with antibiotic therapy. Percutaneous drainage under ultrasound control is the preferred initial drainage procedure in high risk patients.
Most abscesses contain more than one organism and frequently are of biliary or enteric origin. It may be bacterial, protozoal or fungal organisms. Amebic abscesses commonly occur in the right lobe of the liver, often cause elevation of the right hemidiaphragm, and may rupture through the diaphragm into the pleural space.
The clinical presentation of liver abscess is insidious; many patients have symptoms for weeks prior to presentation.Fever and right upper quadrant pain are the most common complaints. Physical examination findings are most notable for right upper quadrant tenderness. Hepatomegaly, liver mass, and jaundice are also common.
During the early stage of abscess formation before the hepatocytes undergo necrosis, a pyogenic liver abscess appears solid. When the liver abscess starts to liquefy, it will appear increasingly fluid with mixed echogenicity at US. At a later stage, when the abscess matures with central liquefaction, it will appear as a predominantly cystic lesion.
Rupture of the ALA into the peritoneal right pleural or pericardial cavity is the most common complication of ALA which occurs frequently in adults.
Diagnostic aspiration should be performed as soon as the diagnosis is made. It can be performed under ultrasonographic or CT guidance and is usually followed by placement of a drainage catheter.
PCD is more effective than percutaneous needle aspiration in the management of liver abscess. Percutaneous needle aspiration can be used as a valid alternative for simple abscesses 5 cm in diameter or smaller.
Repeated percutaneous needle aspiration and PCD are equally efficient in the management of liver abscesses 5 cm or less in longest diameter.
Some authors have presented their experience in nonrandomized studies showing that percutaneous needle aspiration is a safe and effective approach and should be considered a first-line treatment in the management of liver abscess. Most of the abscesses required no more than two aspirations irrespective of size.
Complications of percutaneous drainage include perforation of adjacent abdominal organs, pneumothorax, hemorrhage, and leakage of the abscess cavity into the peritoneum. Immunocompromised patients with multiple diffuse micro abscesses are not candidates for either percutaneous or open surgical drainage and are best treated with high-dose antibiotics. Such patients have the highest mortality rate.