Presentation
Right upper quadrant pain and fever.
Patient Data
A 100×75×90 mm thick-walled multi-loculated lesion with surrounding parenchymal hyper enhancement in the early post-contrast phase is noted at the right liver lobe, most consistent with abscess formation. A small amount of perihepatic fluid is observed.
In addition, three low attenuation hepatic lesions, measuring 35×25 mm (segment IVb), 32×18 mm (segment VII) and 25×22 mm (segment VIII), are depicted, revealing early peripheral, nodular enhancement and centripetal filling. Features are most consistent with hemangioma.
The gallbladder is not seen at anatomical location due to prior resection. Pneumobilia is evident.
A 43×25 mm simple cortical cyst with parapelvic extension is seen at the right kidney. In addition, a few non enhanced simple cortical cysts are seen at both kidneys, with maximum diameters of 15 mm.
Case Discussion
Hepatic abscesses can occur via the hematogenous or biliary spread or direct inoculation in the setting of penetrating trauma or iatrogenic following a procedure.
On imaging, bacterial and fungal abscesses are often multiple, whereas amoebic abscesses are more frequently single.
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