Hepatic amoebiasis, differential diagnosis

• Pyogenic anaerobic hepatic abscess: stinking pus, poor general condition, often icterus, negative serology, sometimes portal-of-entry in the intestine (e.g. colon tumour).

• Subphrenic abscess: sometimes a history of peritonitis or surgery, possibly pleural fluid, negative serology.

• Hydatid cyst: slow development, no fever, no toxaemia, serology positive for Echinococcus, sometimes calcifications on abdominal X-ray, no leukocytosis. Ultrasound may show daughter cysts.

• Biliary cysts: ultrasound shows a thin wall and the content is anechoic, otherwise asymptomatic.

• Haemangioma: hyperreflective on ultrasound, otherwise asymptomatic. On CT scan with dynamic sequences there is a centripetal staining with a delayed isodense appearance to the surrounding liver tissue. On MRI a haemangioma is extremely hyperreflective on T2-weighted images (T2 = “water images”).

• Metastases: ultrasound shows generally (but not necessarily) irregular and hyperreflective structure, central necrosis may occur. Frequently peripheral oedema.

• Hepatoma: no fever or toxaemia, no response to trial therapy, elevated alpha-foeto protein, negative serology, biopsy is diagnostic.

Category: Medicine Notes