A complex liver collection in a febrile patient: size, loculation and liquefaction decide aspiration or drainage; the cluster sign suggests pyogenic, a single subcapsular abscess in a young man from an endemic area suggests amoebic.
Orient first
- Pyogenic abscesses follow biliary disease or portal seeding from bowel sepsis; often multiple clustered locules.
- Amoebic abscess: usually single, right lobe, subcapsular, smooth-walled; serology helps.
- Early abscesses may look solid before liquefying — follow-up imaging shows the evolution.
Acquire the study
- Curvilinear probe with colour Doppler; intercostal views for the dome.
The manoeuvre
- Hypoechoic or complex lesion with internal debris and septations; measure in cm.
- Liquefaction: mobile internal echoes and posterior acoustic enhancement — drainable.
- No internal colour Doppler flow in the liquid centre.
- Biliary tree: dilatation or stones as the source.
What confirms it
- A complex collection with rim enhancement in a septic patient; aspiration confirms.
What licenses you to exclude it
- A normal ultrasound does not exclude small or dome abscesses — CT is the next step.
The classic misread
- Calling an early, still-solid abscess a tumour — repeat after antibiotics.