GI Radiology > Liver > Infection > Bacterial Abscess

Hepatic Infections

Bacterial (pyogenic) abscess

  1. Pathogenesis:
  • 85-90% of all abscesses are bacterial in origin.
     
  • Bacteria gain access to liver via the portal or biliary system. Possible causes are iatrogenic, biliary disease, diverticular disease, trauma, and inflammatory bowel disease.
     
  • E. coli and anaerobes are the two most common offending agents in pyogenic abscess.
     
  • Most pyogenic abscesses occur in the right lobe.
     
  • If left untreated, mortality is 100%.
  1. Radiographic findings:
  • U/S: a) heterogeneous, rounded masses with irregular, thickened walls and poor peripheral definition; b) Fluid and debris inside the abscess can create internal echoes; c) Gas-containing lesion also has acoustic shadowing.
  • CT: a) heterogeneous lesion with irregular margin (arrowhead) and possible peripheral enhancement; b) Internal septations or papillary projections; c) 20% contain gas.

  • Nuclear: a) cold defect on sulfur colloid imaging; b) Increased activity with gallium imaging.
 

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