Analysis of ultrasonic misdiagnosis of bacterial liver abscess

ZHANG meng; WANG Ajiao

doi:10.3969/j.issn.1002-3429.2025.16.001

Abstract：Objective To analyze the ultrasound imaging characteristics and causes of misdiagnosis of bacterial liver abscess(BLA).Methods The ultrasound image data and clinical data of 2 patients withBLA misdiagnosed in our hospital from January 2022 to January 2024 were retrospectively analyzed.Results One patient had dull pain in the right upper abdomen after fatigue,accompanied by nausea and vomiting,and the pain was transferred to the right lower abdomen the next day,accompanied by chills and fever.The patient was diagnosed with acute appendicitis and was not improved after antipyretic and anti-infective treatment.Physical examination showed obvious tension and tenderness in the right lower abdominal muscles.B-ultrasound showed enlargement of the right lower abdominal appendix with wall edema.Exploratory laparotomy revealed mild congestion at the tip of the appendix,and an appendectomy was performed.The symptoms remained after operation.On the fifth day after the operation,the patient suddenly felt severe pain in the right upper abdomen and sweating when going to the toilet,and the pain quickly spread to the whole abdomen.Liver puncture and drainage were performed,purulent fluid was extracted,and Escherichia coli was cultured from the pus.The diagnosis was BLA,and the misdiagnosis lasted 7 d.After anti-infection and drainage treatment,the patient was cured and discharged.The prognosis was good during follow-up.One patient was admitted due to right upper quadrant pain and fever for 1 month,which worsened for 2 d.He had a past history of cholangitis and gallstones.The initial diagnosis of acute suppurative cholangitis with septic shock was made,and the condition improved after anti-shock and anti-infection treatment.The next day,B-ultrasound showed a space-occupying lesion in the right lobe of the liver,and primary liver cancer was considered after enhanced CT examination.After liver puncture and exploratory laparotomy,the final diagnosis was BLA,and the misdiagnosis lasted 6 d.After 6 months of follow-up,the prognosis was good.Conclusion The ultrasound images of BLA have certain characteristics,which are more likely to be misdiagnosed as acute appendicitis and liver cancer.In order to reduce misdiagnosis,doctors need to inquire about the medical history in detail,analyze the ultrasound images carefully,improve the understanding and diagnostic ability of BLA,and avoid the occurrence of missed diagnosis and misdiagnosis.