Hepatic abscess on CT: pearls, pitfalls and diagnostic challenges

Area of Science:

• Radiology
• Medical Imaging
• Gastroenterology

Background:

• Hepatic abscess (HA) presents a global diagnostic challenge, with a high rate of initial misdiagnosis in emergency departments.
• The varied clinical and imaging presentations of HA, influenced by pathogen and type, complicate diagnosis.
• Computed tomography (CT) is the primary imaging modality for evaluating HA.

Purpose of the Study:

• To review characteristic CT imaging features of different hepatic abscess subtypes.
• To differentiate hepatic abscesses from neoplastic mimics.
• To improve the recognition of HA in emergency settings.

Main Methods:

• Pictorial essay format.
• Highlighting key imaging findings for pyogenic, amebic, fungal, and hydatid HA.
• Discussing neoplastic mimickers of HA.

Main Results:

• Pyogenic HA: cluster sign, double target sign.
• Amebic HA: solitary right subcapsular morphology.
• Fungal HA: disseminated microabscess pattern in immunocompromised patients.
• Hydatid HA: daughter cysts with peripheral calcifications.
• Neoplastic lesions can mimic HA.

Conclusions:

• Recognizing specific CT features aids in diagnosing diverse HA subtypes.
• Differentiating HA from mimics is crucial for appropriate management.
• Enhanced CT interpretation improves HA detection in emergency scenarios.