Lin A C-M, Yeh D Y, Hsu Y-H, Wu C-C, Chang H, Jang T-N, Huang C-H
Emergency Department, Shin Kong Wu Ho-Su Memorial Hospital, Taiwan.
Emerg Med J. 2009 Apr;26(4):273-5. doi: 10.1136/emj.2007.049254.
Delayed diagnosis of pyogenic liver abscess remains a challenging problem in the emergency department because of the associated high morbidity and mortality.
To evaluate the sensitivity of ultrasono-graphy in the diagnosis of pyogenic liver abscess in patients presenting to the emergency department and the factors that may influence this sensitivity.
A retrospective study was conducted in patients diagnosed with pyogenic liver abscess in the emergency department (ED) of a tertiary care teaching hospital for a period of 5 years. Between May 2001 and April 2006, 268 patients diagnosed with pyogenic liver abscess were evaluated by ultrasonography and/or CT scanning. The age, sex, clinical presentation, location and number of abscesses and the underlying disease of these two groups were compared.
Of the 268 patients admitted via the ED who were discharged or died with a diagnosis of pyogenic liver abscess, there was a predominance of men (M/F 173/95) and the mean age was 57.6 years (range 17-90). 38 had false negative findings on ultrasonography (sensitivity 85.8%) and required abdominal CT scanning for definitive diagnosis. In the other 230 cases, ultrasonography alone was sufficient for diagnosis. Location of the abscess in segments 4 and 5 of the liver raised the sensitivity of ultrasound for diagnosis, while location in segment 8 was most associated with delayed diagnosis by ultrasonography. Right costal angle knocking pain was significant for pyogenic liver abscess even if ultrasound was negative.
The size and location of the liver abscess and the underlying comorbid diseases may affect the diagnostic sensitivity of ultrasound for pyogenic liver abscess in clinical practice. A high index of suspicion should be maintained in patients with diabetes mellitus, previous biliary tract intervention or gastrointestinal malignancy. Follow-up CT scanning is recommended if right flank knocking pain is present, even if ultrasonography is non-revealing. A diagnostic protocol for liver abscess may be feasible in the future.
由于化脓性肝脓肿相关的高发病率和死亡率，其延迟诊断在急诊科仍然是一个具有挑战性的问题。
评估超声检查对急诊科就诊患者化脓性肝脓肿的诊断敏感性以及可能影响该敏感性的因素。
对一家三级护理教学医院急诊科5年间诊断为化脓性肝脓肿的患者进行回顾性研究。2001年5月至2006年4月期间，对268例诊断为化脓性肝脓肿的患者进行了超声检查和/或CT扫描评估。比较了这两组患者的年龄、性别、临床表现、脓肿位置和数量以及基础疾病。
在通过急诊科入院并诊断为化脓性肝脓肿后出院或死亡的268例患者中，男性占多数（男/女为173/95），平均年龄为57.6岁（范围17 - 90岁）。38例超声检查有假阴性结果（敏感性85.8%），需要腹部CT扫描以明确诊断。在其他230例病例中，仅超声检查就足以诊断。肝4段和5段的脓肿位置提高了超声诊断的敏感性，而8段的脓肿位置与超声延迟诊断最相关。即使超声检查为阴性，右肋角叩击痛对化脓性肝脓肿也具有重要意义。
肝脓肿的大小、位置以及基础合并症可能会影响超声对临床实践中化脓性肝脓肿的诊断敏感性。对于患有糖尿病、既往有胆道干预史或胃肠道恶性肿瘤的患者应保持高度怀疑。即使超声检查未发现异常，如果出现右胁腹叩击痛，建议进行后续CT扫描。未来可能制定肝脓肿的诊断方案。
