Features of localization of liver abscesses – data obtained during ultrasound examination
Dumanskiy Y. V., Zubov A. D., Wilson J. I.
Donetsk National Medical University M. Gorky
Liver abscesses – severe pathology, frequency which has the tendency to increase. The methods of choice in the treatment of liver abscesses currently are aspiration and draining under ultrasound control. For determination of tactics in the treatment of liver abscess, it is particularly necessary to evaluate its localization and inter-relationship with blood vessels and ducts, in which ultrasound examination plays the leading role.
Aims – assess and find reason of frequency of localization of liver abscesses in segments of the liver.
Materials and methods. results of examination and treatment of 744 patients with verified liver abscesses from 1993-2012 were studied. Patients with verified malignant pathologies were excluded from the analysis. Ultrasound examination of the liver was performed on all the patients with US scanners AI-5200, HDI 5000 and Logic 3, convex probe 3.5 МHz in compliance with standardized protocols.
Results. Etiologically liver abscesses were distributed in the following order:
Pyelephlebitic – 534 (71.8 %), post traumatic 108 (14.5%), cholangiogenic 93 (12.5%) contact – 9 (1.2%).
Pyelephlebitic abscesses, as shown in the findings, with certainty are formed often in the right lobe of liver in segments VII – 226 (42.3%), VIII – 168 (31.4%) and V – 104 (19.5%) than in other segments. The given fact in the expressed supposition is as a result of anatomical features – branching angles of segmental branches, coming out from the right branch of portal vein, particularly, angles between the main and branching vessels. For abscesses of other etiologies this trend was not identified. Cholangiogenic abscesses with the same frequency were noted in all segments of the liver, traumatic abscesses were connected with the site of parenchymal injury, and contact abscesses – with topographo-anatomical localization of extra-hepatic source of infestation.
Conclusion. Amongst liver abscesses pyelephlebitic etiology is the dominating one. Most of them – 498 (93.2%) are localized in the right lobe of liver, VII, VIII and V segments, that is necessary to take into account in deciding the tactics in draining as the method of choice of treatment, as well as in the teaching/training in carrying out percutaneous echo-controlled intervention, including access identification, choice of instruments, draining methodology and preparation of corresponding phantoms.