Hepatic abscess

Case contributed by Aric Lee
Diagnosis almost certain


Fever and abdominal pain.

Patient Data

Age: 35 years
Gender: Male

Air-fluid level projected over the right hypochondrium, which appears separate from the colon. The findings are suspicious for a hepatic abscess.


An 8.7 cm rim-enhancing collection in the right hepatic lobe contains intermediate-density fluid (HU ~25) and gas, with an air-fluid level corresponding to the radiographic finding. This is suggestive of a hepatic abscess. Other findings of periportal edema, gallbladder wall edema, and ileus are probably reactive in nature.

Case Discussion

Hepatic abscesses are usually radiographically occult, except when they contain gas and are seen as abnormal air-fluid levels. Occasionally, haustra from overlying colonic loops can cause a similar appearance.

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