Pyogenic liver abscess

Case contributed by Dr Laughlin Dawes

Presentation

Right upper quadrant pain and fever

Patient Data

Age: 75 years
Gender: Female

Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.

CT

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 of a pyogenic liver abscess.

Case Discussion

Percutaneous CT-guided drainage was performed. Heavy growth of Streptococcus milleri was grown.

The most common organisms found in pyogenic liver abscesses are Staphylococcus aureus in children and Escherichia coli in adults. Differential diagnoses include: amoebic abscess, hydatid cyst, cystic metastasis, and biliary cystadenocarcinoma.

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