Ultrasound and hepatic abscess: A successful alliance for the internist

Predictive factors for liver abscess liquefaction degree based on clinical, laboratory, and computed tomography data

BACKGROUND

Effective management of liver abscess depends on timely drainage, which is influenced by the liquefaction degree. Identifying predictive factors is crucial for guiding clinical decisions.

AIM

To investigate the predictive factors of liver abscess liquefaction and develop a predictive model to guide optimal timing of percutaneous drainage.

METHODS

This retrospective study included 110 patients with pyogenic liver abscesses who underwent percutaneous catheter drainage. Patients were divided into a poor liquefaction group (n = 28) and a well liquefaction group (n = 82) based on the ratio of postoperative 24-hour drainage volume to abscess volume, using a cutoff value of 0.3. Clinical characteristics, laboratory indicators, and computed tomography imaging features were compared. A predictive model was constructed using logistic regression and evaluated using receiver operating characteristic curves and five-fold cross-validation.

RESULTS

Independent predictive factors for good liquefaction included the absence of diabetes [odds ratio (OR) = 0.339, P = 0.044], absence of pneumonia (OR = 0.218, P = 0.013), left-lobe abscess location (OR = 4.293, P = 0.041), cystic features (OR = 5.104, P = 0.025), and elevated preoperative serum alanine aminotransferase (ALT) levels (OR = 1.013, P = 0.041). The logistic regression model based on these factors demonstrated an area under the curve of 0.814, with a sensitivity of 90.24% and specificity of 67.86%. Five-fold cross-validation yielded an average accuracy of 83.61% and a kappa coefficient of 0.5209.

CONCLUSION

Pneumonia, diabetes, abscess location, abscess composition, and preoperative serum ALT levels are significant predictors of liver abscess liquefaction. The model can guide clinical decision-making.

Washout on Contrast-Enhanced Ultrasound of Benign Focal Liver Lesions-A Review on Its Frequency and Possible Causes

In all imaging methods, including contrast-enhanced ultrasound (CEUS), enhancement in the late phase (LP) is an important criterion for differentiating between benign and malignant focal liver lesions (FLLs). In general, malignant liver lesions are characterized by hypoenhancement and washout in the LP. A lesion with LP hyperenhancement or isoenhancement in the non-cirrhotic liver is usually benign. However, LP hypoenhancement in benign lesions is not so rare, and is even normal and the standard for some lesions, and there are exceptions for each tumor entity that can represent a diagnostic challenge. Knowing these contrast patterns and exceptions is key for correct diagnosis and patient management. The following narrative review describes the contrast behaviors and the frequency of washout and LP hypoenhancement for common as well as rare benign liver lesions and analyzes its causes.

Management of Pyogenic Liver Abscesses: Contemporary Strategies and Challenges

Pyogenic liver abscesses (PLAs) are a suppurative infection of the hepatic parenchyma responsible for significant morbidity and mortality. PLAs are categorized into a variety of mechanisms: (1) via the portal vein, (2) through the biliary tract, (3) via the hepatic artery, (4) from trauma, (5) contiguously via direct extension, and (6) cryptogenically. The pathogenesis of PLA, which informs treatment, can often be discerned based on host factors, clinical presentation, and causative microorganisms. The Streptococcus anginosus group, hypervirulent Klebsiella pneumoniae , and multidrug-resistant gram-negative pathogens have emerged as microbiologically challenging organisms to treat. The identification of hypervirulent K. pneumoniae should prompt for assessment for metastatic spread and consideration of prolonged antimicrobial treatment. Abdominal imaging is indispensable in characterizing PLAs and facilitating source control interventions. Source control remains the most critical aspect of PLA management, followed by antimicrobial therapy. Empiric antibiotics for PLAs are informed by the suspected etiology of PLA formation. Duration of antimicrobial therapy is individualized and dependent on multiple components, including the success of achieving source control, host factors, mechanism of PLA development, and the illness course of the individual-factoring in clinical, biochemical, and radiographic parameters.

Gastrointestinal Ultrasound in Emergency Setting

Acute bowel diseases are responsible for more than one third of subjects who were referred to the emergency department for acute abdominal pain and gastrointestinal evaluation. Gastrointestinal ultrasound (GIUS) is often employed as the first imaging method, with a good diagnostic accuracy in the setting of acute abdomen, and it can be an optimal diagnostic strategy in young females due to the radiation exposure related to X-ray and computed tomography methods. The physician can examine the gastrointestinal system in the area with the greatest tenderness by ultrasound, thus obtaining more information and data on the pathology than the standard physical examination. In this comprehensive review, we have reported the most relevant indications and advantages to using ultrasound in the investigation of abdominal acute pain.

Point‑of‑care ultrasound for the diagnosis of liver abscess in a patient with HIV in the emergency department: A case report

A liver abscess is an entity that is rarely observed in the emergency department; therefore, it requires timely diagnosis by the clinicians who support this service. The early diagnosis of a liver abscess is challenging as variable and non-specific symptoms are present; furthermore, symptoms may differ in patients with human immunodeficiency virus (HIV) infection. To date, reports on the presentation of diagnostic ultrasound with point-of-care ultrasonography (PoCUS) are limited. The present case report study describes a patient diagnosed with HIV and the presence of a liver abscess confirmed by PoCUS performed in an emergency department. The patient presented with abdominal pain upon palpation in the right hypochondrium and in the thoracoabdominal area, which became more severe with inspiration. PoCUS revealed a hypodense intrahepatic image observed between segments VII and VI, with internal echoes suggestive of a liver abscess. Moreover, it was decided to perform tomography-guided percutaneous drainage of the liver abscess. Antibiotic treatment with ampicillin/sulbactam and IV metronidazole was also commenced. The patient presented clinical improvement and was discharged on the third day.

Not all abolished lung sliding are pneumothorax: the case of a particular lung atelectasis

INTRODUCTION

Lung ultrasound (LUS) is expanding from the field of emergency medicine, also to the pneumological specialist field, becoming part of the diagnostic procedure of lung consolidation.

CASE PRESENTATION

A 78-year-old male was admitted to our emergency department for exertional dyspnea. LUS was performed, thus showing at right hemitorax air interface, A lines pattern, pleural sliding abolished on the whole hemitorax, thus suggesting a pneumothorax, but no evidence of lung point. A scan of lower lung segment showed an absence of the diaphragmatic excursion, suggestive for hemiparalysis of the diaphragm muscle, then confirmed by a subcostal scan. Moreover, at the lower segment of right hemitorax there was mild pleural effusion allowing the visualization of a round-shaped parenchymal consolidation with the absence of air bronchograms.

CONCLUSIONS

LUS allowed the visualization of a particular and rare disease such as anthracosis-associated rounded atelectasis, thus leading to a more correct and faster patient management.