Amebic liver abscess: Clinico-radiological findings and interventional management

Abstract

In its classic form, amebic liver abscess (ALA) is a mild disease, which responds dramatically to antibiotics and rarely requires drainage. However, the two other forms of the disease, i.e., acute aggressive and chronic indolent usually require drainage. These forms of ALA are frequently reported in endemic areas. The acute aggressive disease is particularly associated with serious complications, such as ruptures, secondary infections, and biliary communications. Laboratory parameters are deranged, with signs of organ failure often present. This form of disease is also associated with a high mortality rate, and early drainage is often required to control the disease severity. In the chronic form, the disease is characterized by low-grade symptoms, mainly pain in the right upper quadrant. Ultrasound and computed tomography (CT) play an important role not only in the diagnosis but also in the assessment of disease severity and identification of the associated complications. Recently, it has been shown that CT imaging morphology can be classified into three patterns, which seem to correlate with the clinical subtypes. Each pattern depicts its own set of distinctive imaging features. In this review, we briefly outline the clinical and imaging features of the three distinct forms of ALA, and discuss the role of percutaneous drainage in the management of ALA.

Keywords: Amebic liver abscess, Complicated liver abscess, Refractory liver abscess, Ruptured amebic liver abscess, Pleuropulmonary complication, Biliary communication, Needle aspiration, Catheter drainage

Core Tip: The clinical presentation and imaging findings of amebic liver abscess (ALA) can be classified into three forms: subacute mild, acute aggressive and chronic indolent. The latter two forms are particularly associated with most complications of ALA. Despite this, prior literature primarily focused on the mild form of the disease, which responds well to antibiotics. To the best of our knowledge, there is no research on the types of ALA. In this review, the distinct clinical and imaging characteristics of each type are discussed in detail. With this understanding, the therapeutic strategy, medical or interventional, can be employed more efficiently for patients with ALA.