Pyogenic liver abscess: changing epidemiology and prognosis.

We reviewed the clinical features, methods of diagnosis, and outcome of 31 patients with pyogenic liver abscess seen at a private community hospital between 1973 and 1980. Two patient groups emerged. Group 1 consisted of 25 patients who had classical signs and symptoms of primary liver abscess. Group 2 consisted of six patients, most with underlying malignancy, in whom liver abscess(es) occurred as part of a septicemic process involving multiple other sites. The mortality was 0% in group 1 and 100% in group 2. Further analysis of the patients in group 1 revealed that (1) in contrast to findings of older studies, pyogenic liver abscess in now largely a disease of older adults who often have no identifiable predisposing process; (2) newer noninvasive imaging techniques greatly facilitate a firm diagnosis; and (3) the prognosis for such patients has become remarkably good, perhaps because of earlier diagnosis.