Vascular complications of liver abscess: A literature review

Abstract

Extensive vascular network and proximity to the gastrointestinal tract make the liver susceptible to abscess formation. While pyogenic liver abscesses account for the majority of liver abscesses in the Western world, amebic liver abscesses are more prevalent in tropical and developing nations. Most liver abscesses heal without complications. However, various vascular complications can occur in these patients, including compression of the inferior vena cava, thrombosis of the portal vein and/or hepatic veins, hepatic artery pseudoaneurysm, direct rupture into major vessels or the pericardium, and biliovascular fistula. These complications can present significant clinical challenges due to the potential for haemorrhage, ischemia, and systemic embolism, thereby increasing the risk of morbidity and mortality. Mechanical compression, flow stasis, inflammation, endothelial injury, and direct invasion are some of the proposed mechanisms that can cause vascular complications in the setting of a liver abscess. For the diagnosis, thorough assessment, and therapeutic planning of vascular complications, more sophisticated imaging techniques such as multidetector computed tomography angiography or magnetic resonance angiography may be necessary. Although most vascular complications resolve with abscess treatment alone, additional interventions may be required based on the nature, severity, and course of the complications. This article aims to provide a systematic update on the spectrum of vascular complications of liver abscesses, offering insights into their pathogenesis, diagnosis, and management strategies.