Pyogenic liver abscess complicated by septic pulmonary emboli
A ketoacidotic diabetic patient admitted to the ICU. The patient presented with RUQ abdominal pain, fever, and leukocytosis.
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Poorly-marginated fluid-density lesion in right hepatic lobe that shows peripheral and wispy central enhancement that suggests septa within the lesion. No other liver abnormality seen.
Lung bases show bilateral peripheral small pulmonary nodules in addition to left lower lobe (LLL) wedge-shaped small density. The findings are suspicious for septic pulmonary emboli and small consolidation, respectively.
The patient was treated with IV antibiotics, plus a pigtail drain for the liver abscess. Klebsiella pneumoniae was the responsible pathogen.
Follow up studies show total resolution of the pulmonary nodules and liver abscess.
The association between liver abscess and septic pulmonary emboli in diabetic ketoacidosis is significant, so liver abscess should be excluded from the differential diagnosis for a diabetic patient presenting with dyspnea, acute blurred vision, sleepiness, malaise or even for those without abdominal pain or fever.