Hepatic abscess

Case contributed by Ammar Haouimi
Diagnosis almost certain

Presentation

Right upper quadrant pain with fever, leukocytosis and elevated CRP level in a diabetic patient.

Patient Data

Age: 70 years
Gender: Male
ct

Large irregular fluid-density hepatic mass centered on the segments 7/6 composed of multiple low attenuation coalescent lesions forming the "cluster sign", surrounded by an enhancing inner rim with hypodense outer ring, giving the characteristic "double target sign".

Small gallstone is noted.

Minimal pleural effusion mainly on the right with left pleural calcification.

Area of left lung base atelectasis with traction bronchiectasis and inter-lobular septal thickening on lung window (not shown, previous history of COVID-19 pneumonia).

Left renal scarring with atrophy, cortical thinning and dilatation of the calyceal system and ureter (chronic pyelonephritis). Bilateral cortical renal cysts.

Enlarged prostate (volume 46 mL).

Case Discussion

CT features most consistent with a hepatic abscess in an immunocompromised patient (diabetes mellitus).

Up to 15% of patients with hepatic abscess are found to have diabetes mellitus.

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