Skip to main content

Advertisement

Log in

Beyond pyogenic liver abscess: a comprehensive review of liver infections in emergency settings

  • Review Article
  • Published:
Emergency Radiology Aims and scope Submit manuscript

Abstract

Hepatobiliary infections are commonly encountered in emergency settings ranging from common pathology such as pyogenic abscess to relatively uncommon and rare etiologies. Since extensive literature is already available on imaging of more common bacterial infections, for the sake of focused discussion, this review will discuss radiological appearance of less commonly encountered hepatic infections of fungal, parasitic, viral, and tubercular etiologies. Epidemiological and clinical information remain extremely important for obtaining more accurate presumptive diagnosis. In the era of diverse population migration, a modern-era radiologist must be well versed about the imaging spectrum of liver infections.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15
Fig. 16

Similar content being viewed by others

References

  1. Mortele KJ, Segatto E, Ros PR (2004) The infected liver: radiologic-pathologic correlation. Radio Graphics 24:937–955

    Google Scholar 

  2. Oto A, Akhan O, Ozmen M (1999) Focal inflammatory diseases of the liver. Eur J Radiol 32:61–75

    Article  CAS  PubMed  Google Scholar 

  3. Bächler P, Baladron MJ, Menias C, Beddings I, Loch R, Zalaquett E, Vargas M, Connolly S, Bhalla S, Huete Á (2016) Multimodality imaging of liver infections: differential diagnosis and potential pitfalls. RadioGraphics 36:1001–1023

    Article  PubMed  Google Scholar 

  4. Doyle DJ, Hanbidge AE, O’Malley ME (2006) Imaging of hepatic infections. Clin Radiol 61:737–748

    Article  CAS  PubMed  Google Scholar 

  5. Radin D, Ralls P, Colletti P, Halls J (1988) CT of amebic liver abscess. Am J Roentgenol 150:1297–1301

    Article  CAS  Google Scholar 

  6. Hughes MA, Petri WA Jr (2000) Amebic liver abscess. Infect Dis Clin N Am 14:565–582

    Article  CAS  Google Scholar 

  7. Benedetti NJ, Desser TS, Jeffrey RB (2008) Imaging of hepatic infections. Ultrasound Q 24:267–278

    Article  PubMed  Google Scholar 

  8. Ralls PW, Colletti PM, Quinn MF et al (1982) Sonographic findings in hepatic amebic abscess. Radiology 145:123–126

    Article  CAS  PubMed  Google Scholar 

  9. Jeffrey RB Jr, Tolentino CS, Chang FC et al (1988) CT of small pyogenic hepatic abscesses: the cluster sign. AJR Am J Roentgenol 151:487–489

    Article  PubMed  Google Scholar 

  10. Elizondo G, Weissleder R, Stark DD, Todd LE, Compton C, Wittenberg J, Ferrucci JT Jr (1987) Amebic liver abscess: diagnosis and treatment evaluation with MR imaging. Radiology 165:795–800

    Article  CAS  PubMed  Google Scholar 

  11. Rofsky NM, Fleishaker H (1995) CT and MRI of diffuse liver disease. Semin Ultrasound CT MR 16:16–33

    Article  CAS  PubMed  Google Scholar 

  12. Price JC, Thio CL (2010) Liver disease in the HIV-infected individual. Clin Gastroenterol Hepatol 8:1002–1012

    Article  PubMed  PubMed Central  Google Scholar 

  13. Gore RM, Miller FH, Yaghmai V (1998) Acquired immunodeficiency syndrome (AIDS) of the abdominal organs: imaging features. Semin Ultrasound CT MR 19:175–189

    Article  CAS  PubMed  Google Scholar 

  14. Keaveny AP, Karasik MS (1998) Hepatobiliary and pancreatic infections in AIDS: part one. AIDS Patient Care STDs 12:347–357

    Article  CAS  PubMed  Google Scholar 

  15. Reeders JW, Yee J, Gore RM et al (2004) Gastrointestinal infection in the immunocompromised (AIDS) patient. Eur Radiol 14:E84–E102

    PubMed  Google Scholar 

  16. Bonacini M (1992) Hepatobiliary complications in patients with human immunodeficiency virus infection. Am J Med 92:404–411

    Article  CAS  PubMed  Google Scholar 

  17. Schacker T, Collier AC, Hughes J et al (1997) Clinical and epidemiologic features of primary HIV infection. Arch Intern Med 125:257–264

    Google Scholar 

  18. Pedrosa I, Saíz A, Arrazola J, Ferreirós J, Pedrosa CS (2000) Hydatid disease: radiologic and pathologic features and complications. RadioGraphics 20:795–817

    Article  CAS  PubMed  Google Scholar 

  19. Eckert J, Gemmell MA, Meslin FX, Pawłowski ZS. WHO/OIE manual on echinococcosis in humans and animals: a public health problem of global concern. World Organisation for Animal Health (Office International des Epizooties) and World Health Organization. Paris: WHO; 2001

  20. Working Group WI (2003) International classification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings. Acta Trop 85:253–261

    Article  Google Scholar 

  21. Bristow BN, Lee S, Shafir S, Sorvillo F (2012) Human echinococcosis mortality in the United States, 1990-2007. PLoS Negl Trop Dis 6:e1524

    Article  PubMed  PubMed Central  Google Scholar 

  22. Esfahani F, Roohlamini SA, Vessal K (1988) Ultrasonography of hepatic hydatid cysts: new diagnostic signs. J Ultrasound Med 7:443–450

    Article  CAS  PubMed  Google Scholar 

  23. Niron EA, Ozer H (1981) Ultrasound appearances of liver hydatid disease. Br J Radiol 54:335–338

    Article  CAS  PubMed  Google Scholar 

  24. Marani SA, Canossi GC, Nicoli FA, Alberti GP, Monni SG, Casolo PM (1990) Hydatid disease: MR imaging study. Radiology 175:701–706

    Article  CAS  PubMed  Google Scholar 

  25. Kenney PJ (2002) Echinococcus multilocularis revisited. AJR Am J Roentgenol 178:241–242

    Article  PubMed  Google Scholar 

  26. Didier D, Weiler S, Rohmer P, Lassegue A, Deschamps JP, Vuitton D, Miguet JP, Weill F (1985) Hepatic alveolar echinococcosis: correlative US and CT study. Radiology 154:179–186

    Article  CAS  PubMed  Google Scholar 

  27. Bilgin SS, Toprak H, Seker M (2016) Imaging findings of hepatosplenic schistosomiasis: a case report. Radiol Case Rep 11:152–156

    Article  PubMed  PubMed Central  Google Scholar 

  28. Mortele KJ, Ros PR (2001) Imaging of diffuse liver disease. Semin Liver Dis 21:195–212

    Article  CAS  PubMed  Google Scholar 

  29. Passos MCF, Silva LC, Ferrari TCA, Faria LC (2009) Ultrasound and CT findings in hepatic and pancreatic parenchyma in acute schistosomiasis. Br J Radiol 82:e145–e147

    Article  CAS  PubMed  Google Scholar 

  30. Cesmeli E, Vogelaers D, Voet D, Duyck P, Peleman R, Kunnen M, Afschrift M (1997) Ultrasound and CT changes of liver parenchyma in acute schistosomiasis. Br J Radiol 70:758–760

    Article  CAS  PubMed  Google Scholar 

  31. Nepal P, Ojili V, Songmen S, Batchala P, Kumar D, Nagar AM (2019) Multisystem imaging review of human schistosomiasis: characteristic imaging findings. Clin Imaging 54:163–171

    Article  PubMed  Google Scholar 

  32. Kabaalioglu A, Ceken K, Alimoglu E, Saba R, Cubuk M, Arslan G, Apaydin A (2007) Hepatobiliary fascioliasis: sonographic and CT findings in 87 patients during the initial phase and long-term follow-up. AJR Am J Roentgenol 189:824–828

    Article  PubMed  Google Scholar 

  33. Cevikol C, Karaali K, Senol U, Kabaalioğlu A, Apaydin A, Saba R, Lüleci E (2003) Human fascioliasis: MR imaging findings of hepatic lesions. Eur Radiol 13:141–148

    Article  PubMed  Google Scholar 

  34. Hashmi MA, De JK (2009) Biliary ascariasis on magnetic resonance cholangiopancreatography. J Global Infect Dis 1:144–145

    Article  Google Scholar 

  35. Sundriyal D, Bansal S, Kumar N, Sharma N (2015) Biliary ascariasis: radiological clue to diagnosis. Oxf Med Case Reports 26:246–247

    Article  Google Scholar 

  36. Das CJ, Kumar J, Debnath J, Chaudhry A (2007) Imaging of ascariasis. Australas Radiol 51:500–506

    Article  CAS  PubMed  Google Scholar 

  37. Heffernan EJ, Geoghegan T, Munk PL, Ho SG, Harris AC (2009) Recurrent pyogenic cholangitis: from imaging to intervention. Am J Roentgenol 192:W28–W35

    Article  Google Scholar 

  38. Lim J, Ko Y, Lee D, Kim S (1989) Clonorchiasis: sonographic findings in 59 proved cases. Am J Roentgenol 152:761–764

    Article  CAS  Google Scholar 

  39. Hagspiel KD, Kempf W, Hailemariam S, Marincek B (1995) Mucormycosis of the liver: CT findings. Am J Roentgenol 165:340–342

    Article  CAS  Google Scholar 

  40. Petrikkos G, Skiada A, Lortholary O et al (2013) Epidemiology and clinical manifestations of mucormycosis. Clin Infect Dis 2012:S23–S34

    Google Scholar 

  41. Parfrey NA. Improved diagnosis and prognosis of mucormycosis: a clinicopathologic study of 33 cases, Medicine (Baltimore), 1986, vol. 65 (pg. 113–123)

  42. Lamps LW, Molina CP, West AB, Haggitt RC, Scott MA (2000) The pathologic spectrum of gastrointestinal and hepatic histoplasmosis. Am J Clin Pathol 113:64–72

    Article  CAS  PubMed  Google Scholar 

  43. Radin DR (1991) Disseminated histoplasmosis: abdominal CT findings in 16 patients. AJR Am J Roentgenol 157:955–958

    Article  CAS  PubMed  Google Scholar 

  44. Burrill J, Williams CJ, Bain G, Conder G, Hine AL, Misra RR (2007) Tuberculosis: a radiologic review. Radiographics 27:1255–1273

    Article  PubMed  Google Scholar 

  45. Jadvar R, Mindelzun RE, Olcott EW, Levitt DB (1997) Still the great mimicker: abdominal tuberculosis. AJR Am J Roentgenol 168:1455–1460

    Article  CAS  PubMed  Google Scholar 

  46. Alvarez SZ (1998) Hepatobiliary tuberculosis. J Gastroenterol Hepatol 13:833–839

    Article  CAS  PubMed  Google Scholar 

  47. Jain R, Sawhney S, Gupta RG, Acharya SK (1999) Sonographic appearances and percutaneous management of primary tuberculous liver abscess. J Clin Ultrasound 27:159–163

    Article  CAS  PubMed  Google Scholar 

  48. Yu RS, Zhang SZ, Wu JJ, Li RF (2004) Imaging diagnosis of 12 patients with hepatic tuberculosis. World J Gastroenterol 10:1639–1642

    Article  PubMed  PubMed Central  Google Scholar 

  49. Kawamori Y, Matsui O, Kitagawa K, Kadoya M, Takashima T, Yamahana T (1992) Macronodular tuberculoma of the liver: CT and MR findings. AJR Am J Roentgenol 158:311–313

    Article  CAS  PubMed  Google Scholar 

  50. Nyberg DA, Federle MP, Jeffrey RB, Bottles K, Wofsy CB (1985) Abdominal CT findings of disseminated Mycobacterium avium-intracellulare in AIDS. AJR Am J Roentgenol 145:297–299

    Article  CAS  PubMed  Google Scholar 

  51. Radin DR (1991) Intraabdominal Mycobacterium tuberculosis vs Mycobacterium avium-intracellulare infections in patients with AIDS: distinction based on CT findings. AJR 156:487–491

    Article  CAS  PubMed  Google Scholar 

  52. Lastória JC, Abreu MA (2014) Leprosy: review of the epidemiological, clinical, and etiopathogenic aspects—part 1. An Bras Dermatol 89:205–218

    Article  PubMed  PubMed Central  Google Scholar 

  53. Jones EA, Manaster BJ, May DA et al (2000) Neuropathic osteoarthropathy: diagnostic dilemmas and differential diagnosis. Radiographics 20:S279–S293

    Article  PubMed  Google Scholar 

  54. Mendiratta V, Malik M, Gurtoo A, Chander R (2014) Fulminant hepatic failure in a 15 year old boy with borderline lepromatous leprosy and type 2 reaction. Lepr Rev 85:54–57

    PubMed  Google Scholar 

  55. Ferrari TCA, Arau’jo MG, Ribeiro MMF (2002) Hepatic involvement in lepromatous leprosy. Lepr Rev 73:72–75

    PubMed  Google Scholar 

  56. Choi EK, Lamps LW (2018) Granulomas in the liver, with a focus on infectious causes. Surg Pathol Clin 11:231–250

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We are grateful to our patients from whom we learn.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Vijayanadh Ojili.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nepal, P., Ojili, V., Kumar, S. et al. Beyond pyogenic liver abscess: a comprehensive review of liver infections in emergency settings. Emerg Radiol 27, 307–320 (2020). https://doi.org/10.1007/s10140-020-01757-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10140-020-01757-6

Keywords

Navigation