Pyogenic liver abscess
Right upper quadrant pain and fever.
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CT demonstrates a large irregular fluid-density lesion within the right lobe of the liver with rim enhancement (inner rim) and a thin outer ring of hypoattenuation ("double target sign"). There are multiple smaller peripheral lesions with similar characteristics. Some of these appear coalescent forming "cluster sign". This is the typical appearance for a pyogenic liver abscess.
Percutaneous CT-guided drainage was performed. A heavy growth of Streptococcus milleri was grown.
The most common organisms found in pyogenic liver abscess are Staphylococcus aureus in children and Escherichia coli in adults. Differential diagnoses include: amoebic abscess, hydatid cyst, cystic metastasis, and biliary cystadenocarcinoma.