Liver abscesses can be unexpected and challenging to diagnose and have a variety of appearances. Though in this setting, the relatively low attenuation center, peripheral enhancement, and inflammatory surrounding reaction that we typically associate with abscess elsewhere in the abdomen/pelvis are present, which helps to increase confidence in this diagnosis. The thrombosis of the middle hepatic vein with a small amount of clot leading into the cavoatrial junction is an important finding not to overlook!