138 2^^6 Philippine Journal of Science 1917 



does not move with respiration, and this may be considered a 

 differentiating point. However, exploratory puncture is easily 

 done and settles the diagnosis. 



In abscess occurring in the upper segment of the right lobe 

 of the liver, it is natural to assume that the bulging will take 

 place upward, particularly if the location is near the capsule. 

 This, no doubt, explains the relative frequency of the enlarge- 

 ment of the dome as claimed by Osier. (30) The upward enlarge- 

 ment is often hard, if not impossible, to determine by simple 

 percussion. In such cases as these radiography assists very 

 much in ascertaining whether or not there exists an abscess. 

 Of course, any disease that gives rise to an upward enlargement 

 of the liver will lead the radiologist to suspect abscess of the 

 liver ; hence the necessity of an experienced eye in interpreting 

 the shadows of the dome of the liver. Fernandez (10) states 

 that abscess in the superior surface of the liver causes a differ- 

 ence in the level of the left and right sides of the diaphragm 

 of 6 to 8 centimeters. Twelve of our cases have been referred 

 to the radiologist for confirmation of the diagnosis. In nine cases 

 a positive diagnosis of liver abscess was reported; in one case, 

 it was probable abscess; in another case, only a statement of 

 enlargement of the liver downward was reported ; and in a third 

 case the findings were normal. Among the positive cases, one 

 was of the multiple variety involving the right lobe ; three were 

 abscesses of the lower part of the right lobe of fairly large 

 size, probably sufficiently extensive to involve the upper part 

 of the lobe also; and in four cases the lesion was in the dome. 

 The abscess in the doubtful case was in the lower part of the 

 right lobe; the case with a report of enlargement downward 

 presented an abscess in the lower part also ; and lastly, the case 

 with normal liver had an abscess in the left lobe. 



After analyzing the above results of radioscopic examination 

 of liver abscesses, we cannot accept without question the un- 

 failing value of X-rays as an aid to the diagnosis of liver abscess. 

 However, there is absolutely no doubt that a radiograph, con- 

 sidered in correlation with other symptoms pointing to hepatic 

 abscess, is of great value. 



COMPLICATIONS 



Aside from the colon lesions practically all complications of 

 the liver abscess arise from its spontaneous rupture. Compli- 

 cations which may thus be produced are numerous, their char- 

 acter depending upon the viscera or cavities involved. When 

 the contents of the abscess rupture into the abdominal cavity, 



