Diagnostic and therapeutic approaches to pyogenic abscess of the liver.

A review was conducted of 33 patients with pyogenic hepatic abscesses seen during the past seven years to evaluate the effect of roentgenologic refinements on diagnosis and therapy. Cause, bacterial infection and clinical manifestations were determined. An ultrasonogram was positive in 27 of 29 patients; computed tomographic scan was diagnostic in 20 of 23 patients, and radionuclide studies were positive in eight of 13 patients. Abscesses were confined to the right lobe in 19 patients, to the left lobe in six and were diffuse in eight. In the group of patients with abscesses developing from a biliary route, one patient was successfully managed by roentgenologically controlled drainage while three others required subsequent surgical drainage. Five of seven patients in the biliary route category who were treated with primary surgical drainage were permanently cured. Twelve patients had an abscess emanating from the portal route. In five of these, drainage under roentgenologic control was successful. Two patients upon whom the procedure failed subsequently underwent drainage at operation. Five had primary surgical drainage, and two of these died. All nine patients with post-traumatic, cryptogenic abscesses or an abscess evolving from an arterial route were successfully drained surgically. Three patients with multiple or diffuse abscesses were successfully treated by primary hepatic resection. Refined roentgenologic techniques established the diagnosis of pyogenic abscess in almost all instances. Roentgenologically controlled drainage may be therapeutic in some patients, but surgical drainage remains the standard. Resection has been used as primary treatment in selected patients.