Hepatic abscesses in elderly patients mimicking metastatic disease

Abstract

Background

There is considerable overlap between the clinical presentation and radiological appearances of hepatic abscesses and hepatic metastases. The distinction is important given the treatable nature of hepatic abscesses compared with most forms of metastatic disease and the very high morbidity and mortality associated with untreated or missed pyogenic abscesses.

Aims

The aim of this series of case reports is to illustrate this point by presenting the case histories of three elderly patients whose clinical and radiological findings suggested metastatic liver disease, but who were subsequently proven to have liver abscesses.

Methods

A comprehensive review of the clinical and radiological records of three patients.

Results

Ultrasound and computer tomography (CT) imaging in all three cases was suggestive of metastatic liver disease. The liver lesions were subsequently proven to be abscesses either by autopsy, needle aspiration or inspection at open surgery.

Conclusions

Liver abscesses can mimic metastatic deposits. Correlation with the white cell count (WCC) can be very helpful. Fine needle aspiration (FNA) of liver lesions should be undertaken, especially if the WCC is elevated.