Liver cysts / abscesses

This is an overview of liver cysts and abscesses.
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ADDITIONAL TAGS:
Disease
Agent
Risk factors
Patient
Signs / symptoms
Labs / findings
Diagnosis
Treatment / management
Pyogenic abscess
Poly-
microbial
Recent surgery; comorbid biliary tract dz (gallstones) or diverticulitis; diabetes mellitus
Usually older; M=F
High fever, malaise, acutely ill-appearing; extreme RUQ pain; diaphragmatic irritation
Positive blood cultures; very high bili; very high liver transaminases; high WBC
Imaging (abdomen CT, ultrasound) → well defined, hypoattenuating, round lesion; +/- multiple abscesses
IV antibiotics, abscess drainage; +/- catheter placement. Surgical drainage if not amenable to percutaneous aspiration
Amebic abscess
Entamoeba histolytica (parasite, protozoa)
Travel/residence in resource limited region w contaminated food/water (spread to liver through portal vein)
Usually younger; M F
Can be asymptomatic; usually fever and diarrhea (bloody and/or mucoid); +/- RUQ pain might refer to right shoulder; +/- pleural effusion
High WBC, alk phos, mildly elevated transaminases. Single smooth cystic subcapsular mass on imaging
PCR/antigen test; amebic serology
Medical: Metronidazole or tinidazole + intraluminal antibiotic (eg, paromomycin); no surgery
Hydatid cyst
Echino-
coccus (tapeworm, helminthic)
Travel/residency to endemic area, farm animals (dogs, sheep)
Usually younger; M=F
Usually asymptomatic for years; +/- RUQ pain; +/- HSM; +/- cough/hemoptysis
Eosinophilia. Large and smooth, +/- internal septations (daugher cysts), eggshell calcification on imaging
+/- lung cysts
IgG E granulosus hydatid serology
Surgery + albendazole. Aspiration not recommended (anaphylactic shock from cyst content spillage) but maybe required for larger cysts
Simple hepatic cyst
None. Pathophys: epithelial lining secrets fluid
Believed to be congenital
-
Often asymptomatic; +/- dull RUQ pain; +/- abdominal bloating, +/- early satiety
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incidental on imaging, no calcifications or malignant features
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Liver cysts / abscesses

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