Liver abscess - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Liver abscess is a localized infection in the liver parenchyma that may be bacterial, fungal, or parasitic in origin.
Patients typically present with nonspecific constitutional symptoms, right upper quadrant abdominal pain, and tenderness.
The most common underlying condition in people with pyogenic liver abscess is biliary tract disease.
Treatment of pyogenic abscess focuses on both timely administration of broad-spectrum antibiotics and drainage of the abscess. People with fungal abscess require antifungal therapy. Amebic abscess is treated with a nitroimidazole, followed by a luminal agent.

CT scan showing a liver abscess (7 cm x 5 cm) in a 46-year-old man who presented with fever, fatigue, and cough

From the collection of Massachusetts General Hospital radiology images

Quick Reference

History & Exam
- Key Factors
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Diagnostics Tests
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Treatment Options
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Definition

Epidemiology

Etiology

Pathophysiology

Images

CT scan showing a liver abscess (7 cm x 5 cm) in a 46-year-old man who presented with fever, fatigue, and cough
CT scan (coronal view) showing liver abscess in a 46-year-old man who presented with fever, fatigue, and cough
Gross pathology of amebic abscess of liver; tube of "chocolate" pus from abscess
A noncontrast abdominal CT scan showing a huge gas-containing liver abscess (arrow)

Citations

Key Articles

Feldman M, Friedman LS, Brandt LJ. Brandt. Sleisenger and fordtran's gastrointestinal and liver disease - 2: pathophysiology, diagnosis, management. 11th ed. Elsevier; 2022.

Other Online Resources

IDSA: practice guidelines for outpatient parenteral antimicrobial therapy

Referenced Articles

1. Lam JC, Stokes W. Management of pyogenic liver abscesses: contemporary strategies and challenges. J Clin Gastroenterol. 2023 Sep 1;57(8):774-81.[Abstract]
2. Centers for Disease Control and Prevention. CDC Yellow Book 2024: health information for international travel. Section 5: travel-associated infections & diseases - amebiasis. May 2023 [internet publication].[Full Text]
3. Kaplan GG, Gregson DB, Laupland KB. Population-based study of the epidemiology of and the risk factors for pyogenic liver abscess. Clin Gastroenterol Hepatol. 2004 Nov;2(11):1032-8.[Abstract][Full Text]
4. Mohsen AH, Green ST, Read RC, et al. Liver abscess in adults: ten years experience in a UK centre. QJM. 2002 Dec;95(12):797-802.[Abstract][Full Text]
5. Alvarez J, González J, Baldonedo R, et al. Pyogenic liver abscesses: a comparison of older and younger patients. HPB (Oxford). 2001;3(3):201-6.[Abstract][Full Text]
6. Meddings L, Myers RP, Hubbard J, et al. A population-based study of pyogenic liver abscesses in the United States: incidence, mortality, and temporal trends. Am J Gastroenterol. 2010 Jan;105(1):117-24.[Abstract]
7. Huang CJ, Pitt HA, Lipsett PA, et al. Pyogenic hepatic abscess: changing trends over 42 years. Ann Surg. 1996 May;223(5):600-7.[Abstract][Full Text]
8. Johannsen EC, Sifri CD, Madoff LC. Pyogenic liver abscesses. Infect Dis Clin North Am. 2000 Sep;14(3):547-63.[Abstract]
9. Jepsen P, Vilstrup H, Schønheyder HC, et al. A nationwide study of the incidence and 30-day mortality rate of pyogenic liver abscess in Denmark, 1977-2002. Aliment Pharmacol Ther. 2005 May 15;21(10):1185-8.[Abstract][Full Text]
10. Tsai FC, Huang YT, Chang LY, et al. Pyogenic liver abscess as endemic disease, Taiwan. Emerg Infect Dis. 2008 Oct;14(10):1592-600.[Abstract][Full Text]
11. Petri WA Jr, Singh U. Diagnosis and management of amebiasis. Clin Infect Dis. 1999 Nov;29(5):1117-25.[Abstract][Full Text]
12. Snider C, Petri WA Jr. Travel medicine. In: Rakel RE, ed. Conn's current therapy. 61st ed. New York, NY: W.B. Saunders; 2008:156-64.
13. Johnston V, Stockley JM, Dockrell D, et al; British Infection Society and the Hospital for Tropical Diseases. Fever in returned travellers presenting in the United Kingdom: recommendations for investigation and initial management. J Infect. 2009 Jul;59(1):1-18.[Abstract]
14. Rahimian J, Wilson T, Oram V, et al. Pyogenic liver abscess: recent trends in etiology and mortality. Clin Infect Dis. 2004;39:1654-1659.[Abstract][Full Text]
15. Fang CT, Lai SY, Yi WC, et al. Klebsiella pneumoniae genotype K1: an emerging pathogen that causes septic ocular or central nervous system complications from pyogenic liver abscess. Clin Infect Dis. 2007 Aug 1;45(3):284-93.[Abstract][Full Text]
16. Lederman ER, Crum NF. Pyogenic liver abscess with a focus on Klebsiella pneumoniae as a primary pathogen: an emerging disease with unique clinical characteristics. Am J Gastroenterol. 2005 Feb;100(2):322-31.[Abstract]
17. Alvarez Pérez JA, González JJ, Baldonedo RF, et al. Clinical course, treatment, and multivariate analysis of risk factors for pyogenic liver abscess. Am J Surg. 2001 Feb;181(2):177-86.[Abstract]
18. Rockey DC. Hepatobiliary infections. Curr Opin Gastroenterol. 2001 Jul;17(1):257-61.[Abstract]
19. Feldman M, Friedman LS, Brandt LJ. Brandt. Sleisenger and fordtran's gastrointestinal and liver disease - 2: pathophysiology, diagnosis, management. 11th ed. Elsevier; 2022.
20. Leggieri N, Marques-Vidal P, Cerwenka H, et al. Migrated foreign body liver abscess: illustrative case report, systematic review, and proposed diagnostic algorithm. Medicine (Baltimore). 2010 Mar;89(2):85-95.[Abstract]
21. Thomsen RW, Jepsen P, Sørensen HT. Diabetes mellitus and pyogenic liver abscess: risk and prognosis. Clin Infect Dis. 2007 May 1;44(9):1194-201.[Abstract][Full Text]
22. Molle I, Thulstrup AM, Vilstrup H, et al. Increased risk and case fatality rate of pyogenic liver abscess in patients with liver cirrhosis: a nationwide study in Denmark. Gut. 2001 Feb;48(2):260-3.[Abstract]
23. Shibata T, Yamamoto Y, Yamamoto N, et al. Cholangitis and liver abscess after percutaneous ablation therapy for liver tumors: incidence and risk factors. J Vasc Interv Radiol. 2003 Dec;14(12):1535-42.[Abstract]
24. Neumayr A, Kubitz R, Bode JG, et al. Multiple liver abscesses with isolation of streptococcus intermedius related to a pyogenic dental infection in an immuno-competent patient. Eur J Med Res. 2010;15(7):319-22.[Abstract][Full Text]
25. Rainwater E, Gupta V, Vivekanandan R, et al. Maxillary teeth abscesses result in atypical liver abscesses. Cureus. 2018 Mar 20;10(3):e2353.[Abstract][Full Text]
26. British Society of Gastroenterology. Antibiotic prophylaxis in gastrointestinal endoscopy. Jan 2012 [internet publication].[Full Text]
27. Law ST, Li KK. Role of C-reactive protein in response-guided therapy of pyogenic liver abscess. Eur J Gastroenterol Hepatol. 2014 Feb;26(2):179-86.[Abstract]
28. Simundic AM, Bölenius K, Cadamuro J, et al. Joint EFLM-COLABIOCLI recommendation for venous blood sampling. Clin Chem Lab Med. 2018;56(12):2015-38.[Abstract]
29. American College of Radiology. ACR Appropriateness Criteria: acute nonlocalized abdominal pain. 2018 [internet publication].[Full Text]
30. American College of Radiology. ACR Appropriateness Criteria®: right upper quadrant pain. 2022 [internet publication].[Full Text]
31. Bächler P, Baladron MJ, Menias C, et al. Multimodality imaging of liver infections: differential diagnosis and potential pitfalls. Radiographics. 2016 Jul-Aug;36(4):1001-23.[Abstract]
32. Bonomo RA, Chow AW, Edwards MS, et al. 2024 clinical practice guideline update by the Infectious Diseases Society of America on complicated intra-abdominal infections: risk assessment, diagnostic imaging, and microbiological evaluation in adults, children, and pregnant people. Clin Infect Dis. 2024 Oct 4;79(supplement_3):S81-7.[Abstract][Full Text]
33. Elbanna KY, Kielar AZ. Computed tomography versus magnetic resonance imaging for hepatic lesion characterization/diagnosis. Clin Liver Dis (Hoboken). 2021 Mar;17(3):159-64.[Abstract][Full Text]
34. Everts RJ, Heneghan JP, Adholla PO, et al. Validity of cultures of fluid collected through drainage catheters versus those obtained by direct aspiration. J Clin Microbiol. 2001 Jan;39(1):66-8.[Abstract][Full Text]
35. Chemaly RF, Hall GS, Keys TF, et al. Microbiology of liver abscesses and the predictive value of abscess gram stain and associated blood cultures. Diagn Microbiol Infect Dis. 2003 Aug;46(4):245-8.[Abstract]
36. Lin AC, Yeh DY, Hsu YH, et al. Diagnosis of pyogenic liver abscess by abdominal ultrasonography in the emergency department. Emerg Med J. 2009 Apr;26(4):273-5.[Abstract]
37. Benedetti NJ, Desser TS, Jeffrey RB. Imaging of hepatic infections. Ultrasound Q. 2008 Dec;24(4):267-78.[Abstract]
38. Doyle DJ, Hanbidge AE, O'Malley ME. Imaging of hepatic infections. Clin Radiol. 2006 Dec;61(4):737-48.[Abstract]
39. Hope WW, Vrochides DV, Newcomb WL, et al. Optimal treatment of hepatic abscess. Am Surg. 2008 Feb;74(2):178-82.[Abstract]
40. Ng FH, Wong WM, Wong BC, et al. Sequential intravenous/oral antibiotic vs. continuous intravenous antibiotic in the treatment of pyogenic liver abscess. Aliment Pharmacol Ther. 2002 Jun;16(6):1083-90.[Abstract][Full Text]
41. Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021 Nov 1;49(11):e1063-143.[Abstract][Full Text]
42. European Medicines Agency. Quinolone- and fluoroquinolone-containing medicinal products. 19 March 2019 [internet publication].[Full Text]
43. Giamarellou H. Multidrug resistance in Gram-negative bacteria that produce extended-spectrum beta-lactamases (ESBLs). Clin Microbiol Infect. 2005 Jul;11(suppl 4):1-16.[Abstract]
44. Jacoby GA, Munoz-Price LS. The new beta-lactamases. N Engl J Med. 2005 Jan 27;352(4):380-91.[Abstract]
45. Liu CH, Gervais DA, Hahn PF, et al. Percutaneous hepatic abscess drainage: do multiple abscesses or multiloculated abscesses preclude drainage or affect outcome? J Vasc Interv Radiol. 2009 Aug;20(10):1059-65.[Abstract]
46. Pearce N, Knight R, Irving H, et al. Non-operative management of pyogenic liver abscess. HPB (Oxford). 2003;5(2):91-5.[Abstract][Full Text]
47. Al-Sayaghi KM, Alhujaily M, Zaky MK, et al. Percutaneous needle aspiration versus catheter drainage in the management of liver abscess: an updated systematic review and meta-analysis. ANZ J Surg. 2023 Apr;93(4):840-50.[Abstract]
48. Yu SC, Ho SS, Lau WY, et al. Treatment of pyogenic liver abscess: prospective randomized comparison of catheter drainage and needle aspiration. Hepatology. 2004 Apr;39(4):932-8.[Abstract][Full Text]
49. Zerem E, Hadzic A. Sonographically guided percutaneous catheter drainage versus needle aspiration in the management of pyogenic liver abscess. AJR Am J Roentgenol. 2007 Sep;189(3):W138-42.[Abstract][Full Text]
50. Aldhafeeri JAA, Alkahtani HHN, Mohammed AA, et al. Percutaneous needle aspiration versus catheter drainage in treating hepatic abscess. The Egyptian Journal of Hospital Medicine. 2018;70:21-8. [Full Text]
51. Mahmoud A, Abuelazm M, Ahmed AAS, et al. Percutaneous catheter drainage versus needle aspiration for liver abscess management: an updated systematic review, meta-analysis, and meta-regression of randomized controlled trials. Ann Transl Med. 2023 Mar 15;11(5):190.[Abstract][Full Text]
52. Lin JW, Chen CT, Hsieh MS, et al. Percutaneous catheter drainage versus percutaneous needle aspiration for liver abscess: a systematic review, meta-analysis and trial sequential analysis. BMJ Open. 2023 Jul 30;13(7):e072736.[Abstract][Full Text]
53. Tan YM, Chung AY, Chow PK, et al. An appraisal of surgical and percutaneous drainage for pyogenic liver abscesses larger than 5 cm. Ann Surg. 2005 Mar;241(3):485-90.[Abstract][Full Text]
54. Chung YF, Tan YM, Lui HF, et al. Management of pyogenic liver abscesses: percutaneous or open drainage? Singapore Med J. 2007 Dec;48(12):1158-65.[Abstract][Full Text]
55. Ndong A, Tendeng JN, Diallo AC, et al. Efficacy of laparoscopic surgery in the treatment of hepatic abscess: a systematic review and meta-analysis. Ann Med Surg (Lond). 2022 Mar;75:103308.[Abstract][Full Text]
56. Hsieh HF, Chen TW, Yu CY, et al. Aggressive hepatic resection for patients with pyogenic liver abscess and APACHE II score > or =15. Am J Surg. 2008 Sep;196(3):346-50.[Abstract]
57. Sersté T, Bourgeois N, Vanden Eynden F, et al. Endoscopic drainage of pyogenic liver abscesses with suspected biliary origin. Am J Gastroenterol. 2007 Jun;102(6):1209-15.[Abstract]
58. Ogura T, Masuda D, Saori O, et al. Clinical outcome of endoscopic ultrasound-guided liver abscess drainage using self-expandable covered metallic stent (with video). Dig Dis Sci. 2016 Jan;61(1):303-8.[Abstract]
59. Haque R, Huston CD, Hughes M, et al. Amebiasis. New Engl J Med. 2003 Apr 17;348(16):1565-73.[Abstract]
60. Stanley SL Jr. Amoebiasis. Lancet. 2003 Mar 22;361(9362):1025-34.[Abstract]
61. Chavez-Tapia NC, Hernandez-Calleros J, et al. Image-guided percutaneous procedure plus metronidazole versus metronidazole alone for uncomplicated amoebic liver abscess. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD004886.[Abstract][Full Text]
62. Molton JS, Chan M, Kalimuddin S, et al. Oral vs intravenous antibiotics for patients with klebsiella pneumoniae liver abscess: a randomized, controlled noninferiority Study. Clin Infect Dis. 2020 Aug 14;71(4):952-9.[Abstract][Full Text]
63. Chuang C, Chou SH, Wang FD, et al. Fluoroquinolones as an alternative treatment for Klebsiella pneumoniae liver abscess and impact on hospital length of stay. Int J Antimicrob Agents. 2020 Oct;56(4):106120.[Abstract]
64. Drugs for parasitic infections. Med Lett. 2004 Aug;46:e1-12.
65. Cheng HC, Chang WL, Chen WY, et al. Long-term outcome of pyogenic liver abscess: factors related with abscess recurrence. J Clin Gastroenterol. 2008 Nov-Dec;42(10):1110-5.[Abstract]
66. Webster J, Osborne S, Rickard CM, et al. Clinically-indicated replacement versus routine replacement of peripheral venous catheters. Cochrane Database Syst Rev. 2019 Jan 23;(1):CD007798.[Abstract][Full Text]
67. Fung HB, Doan TL. Tinidazole: a nitroimidazole antiprotozoal agent. Clin Ther. 2005 Dec;27(12):1859-84.[Abstract]
68. Lucasti C, Vasile L, Sandesc D, et al. Phase 2, dose-ranging study of relebactam with imipenem-cilastatin in subjects with complicated intra-abdominal infection. Antimicrob Agents Chemother. 2016 Oct;60(10):6234-43.[Abstract][Full Text]
69. Ruiz-Hernández JJ, León-Mazorra M, Conde-Martel A, et al. Pyogenic liver abscesses: mortality-related factors. Eur J Gastroenterol Hepatol. 2007 Oct;19(10):853-8.[Abstract]
70. Chen SC, Huang CC, Tsai SJ, et al. Severity of disease as main predictor for mortality in patients with pyogenic liver abscess. Am J Surg. 2009 Aug;198(2):164-72.[Abstract]
71. Chen W, Chen CH, Chiu KL, et al. Clinical outcome and prognostic factors of patients with pyogenic liver abscess requiring intensive care. Crit Care Med. 2008 Apr;36(4):1184-8.[Abstract]
72. Mohan BP, Meyyur Aravamudan V, Khan SR, et al. Prevalence of colorectal cancer in cryptogenic pyogenic liver abscess patients. do they need screening colonoscopy? a systematic review and meta-analysis. Dig Liver Dis. 2019 Dec;51(12):1641-5.[Abstract]
73. Lee SS, Chen YS, Tsai HC, et al. Predictors of septic metastatic infection and mortality among patients with Klebsiella pneumoniae liver abscess. Clin Infect Dis. 2008 Sep 1;47(5):642-50.[Abstract][Full Text]
74. Shiba H, Aoki H, Misawa T, et al. Pneumoperitoneum caused by ruptured gas-containing liver abscess. J Hepatobiliary Pancreat Surg. 2007;14(2):210-1.[Abstract]
75. Ukikusa M, Inomoto T, Kitai T, et al. Pneumoperitoneum following the spontaneous rupture of a gas-containing pyogenic liver abscess: report of a case. Surg Today. 2001;31(1):76-9.[Abstract]
76. Ala A, Safar-Aly H, Millar A. Metallic cough and pyogenic liver abscess. Eur J Gastroenterol Hepatol. 2001 Aug;13(8):967-9.[Abstract]
77. Costi R, Bataille N, Cazaban A, et al. Image of the month: cholecystocolonic fistula associated with Escherichia coli liver abscess. Arch Surg. 2009 May;144(5):481-2.[Abstract]
78. Chung SD, Chen KH, Chang HC. Pyelo-hepatic fistula. Urology. 2008 Sep;72(3):524.[Abstract]
79. Monge-Fresse AS, Siriez JY, Bricaire F. Spontaneous fistulisation of a liver abscess into the stomach. Neth J Med. 2007 Dec;65(11):456-7.[Abstract]
80. Syed MA, Kim TK, Jang HJ. Portal and hepatic vein thrombosis in liver abscess: CT findings. Eur J Radiol. 2007 Mar;61(3):513-9.[Abstract]