Radiographic Findings in Hepatic Abscess, Amebic in Type

This is the authors' abstract. We don't add key points for this paper.

THE diagnosis of amebic abscess of the liver is always difficult, and any method of examination that will give information sufficiently definite to warrant earlier surgical intervention is of great value to the patient and will be appreciated by the clinician and surgeon. In the literature very few references are found to the use of X-ray in the diagnosis of this condition, and these few are mostly in British or French literature; only one article, that of Mebane (1), appears in American literature. In their discussion of the condition I am reporting, these writers bring out the same diagnostic points that I am mentioning, but none of them refer to the differential diagnosis between hepatic abscess and certain other confusing conditions. It has been the writer's privilege during the past year to see four cases in which the radiographic findings were sufficiently definite to warrant a diagnosis of abscess in the right lobe of the liver, and in some of the cases, at least, surgical intervention was resorted to and the abscess drained at an earlier date than otherwise would have been the case. These cases were all amebic in type, and for this reason my conclusions are based entirely upon abscesses of this character. I believe, however, that in the main they would apply to hepatic abscesses of any type other than those that are multiple. Method of Examination.—The most positive evidence in these cases is to be gotten with the fluoroscope, and if possible the examination should be made with the patient erect. While plates are of value, they cannot be substituted for the fluoroscopic examination, and their principal value is for the purpose of record. Fluoroscopic Findings.—The right diaphragm is elevated from one to several intercostal spaces, and its excursion is limited or entirely absent. The right costophrenic angle is increased in acuteness, and in cases in which the abscess is located near the superior surface of the liver, a rounded elevation can be seen on the superior surface of the diaphragm. The whole liver shadow is enlarged, and in uncomplicated cases the lung fields are normally radiant. The limitation in the movement of the diaphragm is most characteristic, presenting an entirely different picture from that seen in limitation of movement due to pathology above the diaphragm, the limitation of movement in these cases being the result of rigidity, the same as seen in other abdominal muscles in acute inflammatory conditions within the abdomen. In one article reviewed, that of P. Heyman, pneumoperitoneum is advised. While I have had no experience with this method, it does seem to me that it might, under certain conditions, be an extremely hazardous procedure, due to the fact that pressure of the air introduced might result in the laceration of adhesions and dissemination of the infection.