European Journal of Radiology 74 (2010) 195–198 Contents lists available at ScienceDirect European Journal of Radiology journal homepage: www.elsevier.com/locate/ejrad Long-term follow-up of pyogenic liver abscess by ultrasound Sudhamshu K.C. ∗ , Dilip Sharma Liver Unit, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal article info Article history: Received 1 October 2008 Received in revised form 8 January 2009 Accepted 15 January 2009 Keywords: Pyogenic liver abscess Ultrasound Residual abscess abstract Background/aims: To study the morphology of residual abscess in successfully treated pyogenic liver abscess by ultrasound. Methods: 116 consecutive patients of liver abscess diagnosed from April 2004 to March 2007 were included in this study. Patients with amebic liver abscess were excluded. Patients were treated with antibiotics for 6 weeks and when indicated drained percutaneously. Ultrasound scan was repeated after 2 weeks, 1 month, 3 months, 6 months and 12 months of treatment. Thereafter it was repeated every 6 months. Results: After exclusion, 102 patients with >150 lesions were studied. Diagnosis was made on the basis of clinical presentation, ultrasound examination and diagnostic aspiration. It was single in 83, double in 12 and more than 2 in seven patients. Size varied from 4.2cm to 15cm. Organisms were isolated in 29 patients (E. coli 10, Kliebsiella sp. 6, S. aureus 5, Pseudomonas aeruginosa 2, Acenetobacter 1 and multiple growth 5) in blood and eight patients (E. coli 5 and S. aureus 3 and multiple growth 2) in pus. Majority of abscess resolved sonologically after 2–18 weeks of treatment. Healing was delayed in alcoholic and diabetic patients. In eight patients there was residual abscess even after 104 weeks of follow-up. In four patients it healed with calcification. Conclusions: Majority of pyogenic liver abscess resolve to normal parenchyma within 18 weeks time. How- ever, some lesions may take longer time to heal even after successful treatment. It should be considered in differential diagnosis of space occupying lesion of the liver in ultrasound and need no therapeutic intervention. © 2009 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Liver abscess, both amebic and pyogenic, still remains a prob- lem in Nepal. However, in last few years the numbers of the patient in our unit is decreasing. This may be attributed to increase in awareness regarding healthy practices. In past, amebic liver abscess used to be common than pyogenic liver abscess (PLA) in Nepali patients [1]. However, the pyogenic liver abscess has outnumbered amebic liver abscess in recent years. Once the patients are treated for the abscess they tend to repeat ultrasound without consulta- tion with the physician whenever there is any abdominal pain or febrile illness due to any cause. If repeated earlier the persistent residual abscess may cause psychological fear in patients and diag- nostic dilemma to the treating physician. Sometimes it leads to unnecessary investigations. It is important to know the time of disappearance or complete healing in the endemic zone as many patients undergo unnecessary investigations to establish the diag- nosis of space occupying lesion that appear in the ultra sonogram ∗ Corresponding author at: Liver Unit, National Academy of Medical Sciences, GPO Box No. 2983, Kathmandu, Nepal. Tel.: +977 1 4215709; fax: +977 1 4215709. E-mail address: sudhamshu.liver@gmail.com (S. K.C.). even after complete treatment. So, this study was carried out to study the morphology of PLA after treatment and to find out what was the average time of healing of the abscesses. 2. Materials and methods This study was prospectively designed intention-to-treat study. Consecutive patients with a diagnosis of liver abscess attending Liver Unit of Bir Hospital and Norvic International Hospital Kath- mandu, Nepal from April 2004 to March 2007 were enrolled in this study. Diagnosis was confirmed by clinical examination, lab- oratory parameters and diagnostic aspiration. Aspiration was done by 22 G needle or lumbar puncture needle. Patients with amebic liver abscess (anchovy sauce appearance of the pus) were excluded from the study. Blood and pus were sent for culture sensitivity examination before initiating the treatment. Beside culture, blood for hemogram, liver function test and C-reactive protein was sent. Patients were treated with oral and/or intravenous antibiotics for 6 weeks. Those patients who fulfilled the criteria of aspiration underwent therapeutic aspiration. The indications set for aspi- rations were: (a) not responding to antibiotic therapy, (b) size more than 10 cm, (c) left lobe abscess and (d) impending rupture. Ultrasound was repeated after 2 weeks, 1 month, 3 months, 6 0720-048X/$ – see front matter © 2009 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ejrad.2009.01.017