Presentation
A diabetic patient presented with fever, right-sided abdominal pain and swelling.
Patient Data
The liver is grossly enlarged and harbors a huge subcapsular hypodense collection (HU 10) with air-fluid level in its right lobe, compressing the adjacent liver parenchyma.
Characteristic double target sign of liver abscess is noted.
The collection measures about 21.4 x 9.5 x 14.7 cm (CC x TR x AP).
The intrahepatic ducts are not dilated.
The adjacent structures are compressed and displaced to the left.
Mild right pleural effusion at the lung bases.
Case Discussion
Hepatic abscesses are localized collections of necrotic inflammatory tissue caused by bacterial, parasitic, or fungal agents. It is common in those with co-morbidities such diabetes where the person is immunocompromised,
CT-scan is the modality of choice. It demonstrates the characteristic "double target sign" of liver abscess on contrast-enhanced studies; see the axial plane superior sections of case in which a central, fluid-filled low attenuation lesion is surrounded by a high attenuation inner rim (abscess membrane) and a low attenuation outer ring (edematous parenchyma).
A total of 1300 mls of pus was drained, and the patient was discharged home with antibiotics after admission for one day.