Ruptured pyogenic liver abscess

Case contributed by Dr Ngo Tuan Minh

Presentation

Presented with abdominal pain and fever three days before admission

Patient Data

Age: 60 years
Gender: Male

CT shows the multilocular cystic mass in segment 5 abutting the gallbladder, the confluence of multiple locules producing the cluster sign of a pyogenic liver abscess, the double target sign with the enhancement of the inner wall of the abscess in contrast phase, and progressive enhancement of the outer layer in the delayed phase. The lower pole of the hepatic abscess demonstrates a discontinuous border, indicating the rupture site. Right paracolic fat stranding and right paracolic gutter fluid collection which extends into the pelvis.

Case Discussion

This case illustrates the typical features of a ruptured pyogenic liver abscess. 

The patient presented with fever and abdominal pain. The white blood cell count was 20x109/L with 80% neutrophils. CT shows the findings of a pyogenic liver abscess with rupture. 

The diagnosis was confirmed at the surgery. The peritoneal effluent was cultured and yielded Klebsiella pneumoniae.

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Case information

rID: 87291
Published: 28th Feb 2021
Last edited: 7th Mar 2021
Inclusion in quiz mode: Included

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