A review of 20 cases of pyogenic liver abscesses seen from 1971 through 1976 is presented. In this five-year interval, no amebic liver abscesses were found. The primary inflammatory processes were evenly divided among those patients with biliary, urinary, and intraperitoneal disease. Intensive antibiotic therapy was less efficient in sterilizing the abscess than the blood stream. The nebulous histories, clinical findings, and routine laboratory studies emphasize the difficulty in establishing an early diagnosis of liver abscess. Radioisotopic scanning of the liver proved to be the most reliable tool not only for the diagnosis but also for monitoring the postoperative course of the drained cavities. The overall mortality of pyogenic liver abscesses was 45% and the greatest mortality occurred in those patients over 40. Closed needle aspiration of pyogenic liver abscess in the elderly poor-risk patient in conjunction with the appropriate antibiotics may offer an acceptable alternative.