Presentation
Right upper quadrant pain with fever and vomiting.
Patient Data
Enlarged liver with a focal lesion occupying most of the right hepatic lobe. It has a heterogenous echotexture with an irregular thick wall and absent central perfusion on doppler ultrasound.
Remainder of liver parenchyma seen with homogenous echogenicity.
Distended gallbladder with normal wall thickness and no evidence of calculi.
Large heterogenous multiloculated cystic lesion in segments V to VIII of the liver with peripherally enhancing wall on post-contrast studies, surrounding edema and multiple gas locules. Cluster sign is seen suggestive of pyogenic liver abscess. Percutaneous pig-tail catheter is placed in situ.
Small amount of peri-hepatic and peri-cholecystic free fluid and mildly thickened edematous gallbladder wall. Mild free fluid in the para-colic and pelvic areas.
Remainder of the liver parenchyma shows heterogenous edematous attenuation. The portal and hepatic veins are normally enhancing.
Bilateral pleural effusion, more extensive on the right with right sided basal atelectatic changes.
Case Discussion
This case demonstrates bacterial pyogenic liver abscess and the patient underwent ultrasound guided percutaneous drainage with culture of the drained fluid positive for bacterial organism E.Coli.