Space occupying lesions of the liver and their differential diagnosis

Bahk, H Y; Lee, K Y

Abstract

Cold areas in scintiphotoscan of amebic abscess, pyogenic abscess, hepatoma and metastatic carcinoma look all alike without distinguishing features. But since the hepatic blood flow, which can be estimated by simple externalcounting of disappearing radioactivity from peripheral blood of colloidal 198 Au varies according to the type of disease, the combination of both tests may augment diagnostic specificity. We studied retrospectively 53 cases ofamebic abscess, 15 cases of pyogenic abscess, 59 cases of hepatoma and 28 cases of metastatic carcinomata fromvarious primary sites. The present study revealed that blood clearance rates were accelerated in 41.5% of patientswith amebic abscess and in 46.4% of those with metastatic carcinomata, whereas clearance rates were delayed in 76.3% of patients with hepatoma. The clearance rates remained unchanged in those with pyogenic abscess. It emerges, therefore, that when a cold area is found in connection with an accelerated blood clearance rate then itis quite likely that the cold area represents either amebic abscess or metastatic carcinomata. The reverse hold sin hepatoma. No change in clearance rates should raise the possibility of a pyogenic abscess.