Chapter 351 Liver Abscess
Signs and symptoms are nonspecific and can include fever, chills, night sweats, malaise, fatigue, nausea, abdominal pain with right upper quadrant tenderness, and hepatomegaly; jaundice is uncommon. Diagnosis can be challenging and is often delayed; a high index of suspicion is necessary in children with risk factors. Serum aminotransferase and more often the alkaline phosphatase levels are elevated. The erythrocyte sedimentation rate is high, and leukocytosis is common. The results of blood cultures are positive in 50% of patients. Chest x-rays might show elevation of the right hemidiaphragm with decreased mobility or a right pleural effusion. Ultrasound or CT can confirm diagnosis (Figs. 351-1 to 351-3). Solitary liver abscesses (70% of cases) in the right lobe of the liver (75% of cases) are more common than multiple abscesses or solitary left lobe abscesses.
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