Case of the Week: Amebic Liver Abscess (Ultrasound & CT)

In this radiology lecture, we discuss the ultrasound and CT appearance of amebic liver abscess.

Key points include:

Entamoeba histolytica infection.
Endemic in Africa, Southeast Asia, and Central & South America.
More common in males.
Presents as right upper quadrant pain, fever and hepatomegaly.
Both amebic and pyogenic (bacterial) abscesses can have a layered wall with the “double target” or “double rim” sign.
Amebic more likely to be unilocular (septations present in 30%) without “cluster” sign typical of multiloculated pyogenic abscess.
Amebic more likely solitary, pyogenic more likely multiple.
Can be treated medically (metronidazole), but if diagnosis uncertain, if there is failed response to medical therapy, or if large abscess at risk for rupture = aspiration.

Bächler P, Baladron MJ, Menias C, et al. Multimodality Imaging of Liver Infections: Differential Diagnosis and Potential Pitfalls. RadioGraphics 2016 36:4, 1001-1023.

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