Liver abscess secondary to appendiceal phlegmon

Case contributed by Dr. Jorge Gomez Constain

Presentation

18 year old man with 7 days of fever, urinary symptoms, abdominal pain and jaundice. Initially treated with oral antibiotics for urinary infection with no improvement.

Patient Data

Age: 18
Gender: Male
Modality: Ultrasound


Initially US showed a hypoechogenic lesion in the right hepatic lobe and free fluid in the pelvis. 

On ultrasound, there is a single well defined lesion in the right hepatic lobe with internal echoes and close to the gallbladder. Free fluid was noted in the pelvis (not shown).

On CT scan the hypodense lesion were detected in liver parenchyma.

CT show that lesion is enhanced with contrast and is suggestive of an hepatic abscess.

CT also shows an appendicolith and signs of appendicular abscess.

3 days later CT scan shows the abscess with the percutaneous pigtail catheter inside the lesion.

Modality: Photo

Pigtail catheter is placed inside the liver abscess with guided CT scan. 150 mL of purulent material was obtained.

Percutaneous drainage was performed and the diagnosis was confirmed. No surgery was necessary for treatment of the appendicular phlegmon.

Case Discussion

Pyogenic liver abscesses may result from an unchecked accute appendicitis or an appendiceal phlegmon when the infection invades the portal vein (pylephlebitis). 

Liver abscess have a classic triad of fever, right upper quadrant pain and jaundice.

Antibiotical treatment and percutaneal drainage can improve the pathology and is not necessary any surgical procedure in some cases.

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Case Information

rID: 42025
Case created: 1st Jan 2016
Last edited: 10th Jan 2016
Inclusion in quiz mode: Excluded

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