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Hepatic abscesses in elderly patients mimicking metastatic disease
R S Ryan1, H Al-Hashimi, M J Lee
1Department of Radiology, Beaumont Hospital, Dublin, Ireland.
Background:
There is considerable overlap between the clinical presentation and radiological appearances of hepatic abscesses and hepatic metastases. The distinction is important given the treatable nature of hepatic abscesses compared with most forms of metastatic disease and the very high morbidity and mortality associated with untreated or missed pyogenic abscesses.
Aims:
The aim of this series of case reports is to illustrate this point by presenting the case histories of three elderly patients whose clinical and radiological findings suggested metastatic liver disease, but who were subsequently proven to have liver abscesses.
Methods:
A comprehensive review of the clinical and radiological records of three patients.
Results:
Ultrasound and computer tomography (CT) imaging in all three cases was suggestive of metastatic liver disease. The liver lesions were subsequently proven to be abscesses either by autopsy, needle aspiration or inspection at open surgery.
Conclusions:
Liver abscesses can mimic metastatic deposits. Correlation with the white cell count (WCC) can be very helpful. Fine needle aspiration (FNA) of liver lesions should be undertaken, especially if the WCC is elevated.
Insights
Liver abscesses can mimic metastatic liver disease on imaging. Early diagnosis, aided by elevated white cell count and fine needle aspiration, is crucial for effective treatment.
Area of Science:
- Hepatology
- Radiology
- Oncology
Background:
- Hepatic abscesses and metastases share overlapping clinical and radiological features.
- Distinguishing between these conditions is critical due to the treatable nature of abscesses versus the often-poor prognosis of metastatic disease.
- Untreated pyogenic liver abscesses carry significant morbidity and mortality risks.
Observation:
- This series presents three elderly patients with initial clinical and radiological findings suggestive of liver metastases.
- Imaging studies, including ultrasound and CT, were inconclusive in differentiating between abscesses and metastases.
- The patients' conditions were ultimately diagnosed as liver abscesses through autopsy, needle aspiration, or surgical inspection.
Findings:
- Radiological imaging (ultrasound, CT) can be misleading, appearing similar for both liver abscesses and metastases.
- Elevated white cell count (WCC) serves as a valuable indicator for potential liver abscesses.
- Fine needle aspiration (FNA) is a key diagnostic tool, especially when WCC is elevated.
Implications:
- Liver abscesses can present as metastatic deposits, necessitating careful diagnostic consideration.
- Integrating WCC and FNA results improves the accuracy of diagnosing liver abscesses.
- Prompt and accurate diagnosis of liver abscesses is vital for timely and appropriate patient management.