Sonographic evaluation of hepatic abscesses.

A retrospective study of 37 patients with liver abscesses evaluated by diagnostic ultrasonography suggests that an abscess evolves from a small solid inflammatory focus to a well defined fluid-filled cavity over a variable time interval. Initial scans on six patients revealed a single nonspecific poorly defined solid liver mass. Following diagnostic aspiration, four of these patients were successfully treated with antibiotics alone. Two other patients with initial subtle solid masses went on to develop a more classical cystic abscess cavity with time. The remaining 31 patients had abscess which appeared initially as fluid-filled or cystic masses with variable internal echogenicity, through transmission, and margination. One-half of the patients presented acutely with fever, right upper quadrant pain, and chills. The remaining patients had a more variable indolent presentation with five patients having a course lasting over one month. Eleven patients had associated biliary tract disease. Drainage was performed on 33 patients, 30 by open surgery and three percutaneously with ultrasound guidance. There were no deaths related to sepsis in our series.