| Lin AC |
------>authors3_c= ------>paper_class1=1 ------>Impact_Factor=1.347 ------>paper_class3=2 ------>paper_class2=1 ------>vol=26 ------>confirm_bywho=None ------>insert_bywho=m001043 ------>Jurnal_Rank=38.5 ------>authors4_c= ------>comm_author= ------>patent_EDate=None ------>authors5_c= ------>publish_day=1 ------>paper_class2Letter=None ------>page2=275 ------>medlineContent= ------>unit=000 ------>insert_date=20091014 ------>iam=5 ------>update_date=None ------>author=?? ------>change_event=2 ------>ISSN= ------>authors_c= ------>score=500 ------>journal_name=Emerg Med J ------>paper_name=Diagnosis of pyogenic liver abscess by abdominal ultrasonography in the emergency department ------>confirm_date=None ------>tch_id=089173 ------>pmid=19307388 ------>page1=273 ------>fullAbstract=BACKGROUND: Delayed diagnosis of pyogenic liver abscess remains a challenging problem in the emergency department because of the associated high morbidity and mortality. OBJECTIVE: To evaluate the sensitivity of ultrasono-graphy in the diagnosis of pyogenic liver abscess in patients presenting to the emergency department and the factors that may influence this sensitivity. METHODS: A retrospective study was conducted in patients diagnosed with pyogenic liver abscess in the emergency department (ED) of a tertiary care teaching hospital for a period of 5 years. Between May 2001 and April 2006, 268 patients diagnosed with pyogenic liver abscess were evaluated by ultrasonography and/or CT scanning. The age, sex, clinical presentation, location and number of abscesses and the underlying disease of these two groups were compared. RESULTS: Of the 268 patients admitted via the ED who were discharged or died with a diagnosis of pyogenic liver abscess, there was a predominance of men (M/F 173/95) and the mean age was 57.6 years (range 17-90). 38 had false negative findings on ultrasonography (sensitivity 85.8%) and required abdominal CT scanning for definitive diagnosis. In the other 230 cases, ultrasonography alone was sufficient for diagnosis. Location of the abscess in segments 4 and 5 of the liver raised the sensitivity of ultrasound for diagnosis, while location in segment 8 was most associated with delayed diagnosis by ultrasonography. Right costal angle knocking pain was significant for pyogenic liver abscess even if ultrasound was negative. CONCLUSIONS: The size and location of the liver abscess and the underlying comorbid diseases may affect the diagnostic sensitivity of ultrasound for pyogenic liver abscess in clinical practice. A high index of suspicion should be maintained in patients with diabetes mellitus, previous biliary tract intervention or gastrointestinal malignancy. Follow-up CT scanning is recommended if right flank knocking pain is present, even if ultrasonography is non-revealing. A diagnostic protocol for liver abscess may be feasible in the future. ------>tmu_sno=None ------>sno=22561 ------>authors2=Yeh DY ------>authors3=Hsu YH ------>authors4=Wu CC ------>authors5=Chang H ------>authors6=Jang TN, Huang CH ------>authors6_c= ------>authors=Lin AC ------>delete_flag=0 ------>SCI_JNo=None ------>authors2_c= ------>publish_area=0 ------>updateTitle=Diagnosis of pyogenic liver abscess by abdominal ultrasonography in the emergency department. ------>language=2 ------>check_flag=None ------>submit_date=None ------>country=None ------>no=4 ------>patent_SDate=None ------>update_bywho=None ------>publish_year=2009 ------>submit_flag=None ------>publish_month=4 |