Clinical differentiation of abscess from neoplasm in newly diagnosed space-occupying lesions of the liver

The clinical presentations of liver abscess, hepatoma, and metastatic tumor to the liver may be quite similar, and procedures such as computerized tomography,. radionuclide scanning, and ultrasonography of the liver cannot make a specific diagnosis. Therefore, we compared the clinical presentations of 38 patients seen during the last five years with liver abscess (13 patients), hepatoma (eight patients), and undifferentiated carcinoma metastatic to the liver (17 patients). Patients with liver abscess were distinguished from the other two groups by a significantly shorter prodrome, a history of known risk factors for liver abscess, fever, leukocytosis, and a normal-sized liver (P values all <. 1). A finding of three or more of these criteria correctly identified all cases of liver abscess. Only one of the 25 patients with neoplasms had three of the criteria. The presence of multiple or single lesions, abdominal pain, weight loss, or liver function abnormalities did not differ significantly among the three groups. Thus patients with liver abscess can be reliably differentiated from patients with hepatic neoplasms by clinical criteria alone, and appropriate empiric antibiotic therapy can be started while the diagnosis is being confirmed.