Spot Diagnosis

Pyogenic liver abscess

Pyogenic abscesses can also present as an acute abdomen. As compared to amebic liver abscesses, pyogenic lesions are often multiple and confluent and seem to show less parenchymal edema than amebic lesions.

Amebic liver abscess

This is a 35-years old man who presented with acute pain in the right hypochondrium as well as in the right iliac fossa. The CT (Fig. 1) shows a hypodense lesion showing a thin, irregular wall (arrowhead), with surrounding parenchymal edema (arrow). This appearance is pathognomonic of an amebic liver abscess. The image through the right iliac fossa (Fig. 2) shows marked cecal wall thickening, representing typhlitis, which often is found in acute settings.

Acute abdomen

Each Wednesday morning, we will put one example of the use of CT in acute abdomen. As a one-top modality, CT can pick up virtually every cause of an acute abdomen, save an ectopic pregnancy.

1. Amebic liver abscess

2. Pyogenic liver abscess

3. Liver abscess

4. Acute cholecystitis

5. Acute choledocholithiasis

6. Acute mild pancreatitis

7. Acute mild pancreatitis with small acute fluid collection

8. Acute severe pancreatitis

9. Acute severe pancreatitis

10. Acute severe pancreatitis with infected necrosis

11. Pancreatitis - aspiration of fluid collections

12. Severe pancreatitis - abscess drainage