Hepatic abscess

Case contributed by Dr Varun Babu

Presentation

Acute onset epigastric pain. No prodrome. Total white cell count > 15000.

Patient Data

Age: 65 years
Gender: Male
CT

CT liver at time of presentation

Fairly well defined poorly enhancing lesion with air foci within is seen in the left lobe of liver. Vessels seem to freely traverse the lesion. 

No intra hepatic biliary dilatation, no other focal liver lesions. Normal opacification of hepatic vasculature. 

CT

CT liver 48 hours after presentation and lesion drain tube insertion

Attempted pig tail for drainage did not provide any diagnostic or therapeutic relief. 

Follow up CT just identified the drainage tube in situ in the lesion. Patient was clinically improving. 

CT

Day 10 CT with patient worsening clinically

Absence of air foci within lesion with the lesion appearing to be in a more liquefactive phase. However there is extensive wall enhancing ascitic fluid all around the liver extending inferiorly into the right paracolic gutter. Another pocket is also seen in the perisplenic and left paracolic gutter. 

Case Discussion

This case in hand is a good demonstration of a hepatic abscess in evolution. The relatively solid hepatic lesion along with intravenous antibiotic therapy appeared liquefied in a week's time. Liver abscesses can breach the liver capsule and result in secondary spread of infection into the peritoneum as identified in the follow up CT. 

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Case information

rID: 47865
Case created: 6th Sep 2016
Last edited: 15th Sep 2016
Inclusion in quiz mode: Included

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