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Diagnostic and therapeutic strategies of pyogenic liver abscess
Abstract:
The infectious routes and etiologies of 26 cases with pyogenic liver abscess were portal spread in one, hematogenous in three, biliary in 12, transarterial embolization (TAE) in three, posthepatectomy in one and cryptogenic in five cases. Portal and hematogenous cases tend to show solitary and cystic pattern on echogram, and the majority of the bacteria detected was Klebsiella. While most biliary cases show multiple and cystic with tumor pattern on echogram, and an unhomogeneous low density in CT feature, anaerobic bacteria and candida were isolated only from the biliary or TAE cases. Most cases could be cured completely by the various kinds of abscess drainage, but two TAE cases with PTAD (percutaneous transhepatic abscess drainage) and two biliary cases with PTBD (PT-biliary drainage) and PTAD died due to a delay in establishing a diagnosis and to the severity of the condition. An early diagnosis followed by PTAD or PTBD were thought to be of prime importance.
Insights
Pyogenic liver abscesses have diverse origins, with biliary spread being most common. Early diagnosis and drainage, such as percutaneous transhepatic abscess drainage (PTAD) or PT-biliary drainage (PTBD), are crucial for survival.
Area of Science:
- Hepatology
- Infectious Diseases
- Radiology
Background:
- Pyogenic liver abscess (PLA) is a serious intra-abdominal infection.
- Understanding the diverse etiologies and imaging features of PLA is essential for effective management.
Purpose of the Study:
- To analyze the infectious routes, clinical characteristics, and outcomes of patients with pyogenic liver abscess.
- To evaluate the effectiveness of different drainage methods and emphasize the importance of early diagnosis.
Main Methods:
- Retrospective analysis of 26 cases of pyogenic liver abscess.
- Review of infectious routes, etiological factors, and imaging findings (echogram, CT).
- Assessment of treatment outcomes, including abscess drainage procedures like PTAD and PTBD.
Main Results:
- Biliary (46%) and cryptogenic (19%) routes were the most frequent causes of PLA.
- Klebsiella was the predominant pathogen in portal and hematogenous spread.
- Anaerobic bacteria and Candida were primarily found in biliary or transarterial embolization (TAE) cases.
- While most cases were cured with drainage, delayed diagnosis led to mortality in some TAE and biliary cases.
Conclusions:
- Diverse etiologies contribute to pyogenic liver abscess, with biliary spread being most common.
- Imaging features vary depending on the infectious route.
- Prompt diagnosis and appropriate drainage interventions (PTAD, PTBD) are critical for improving patient survival and outcomes.