IMPORTANT: We currently have a number of bugs related to image cropping and are actively trying to resolve them. In the meantime, we have disabled cropping. Apologies for any inconvenience. Stay informed: radiopaedia.org/chat

Liver abscess secondary to appendiceal phlegmon

Case contributed by Jorge Gomez Constain
Diagnosis certain

Presentation

7 days of fever, urinary symptoms, abdominal pain and jaundice. Initially treated with oral antibiotics for urinary infection with no improvement.

Patient Data

Age: 18 years
Gender: Male

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

Initially, US showed a hypoechogenic lesion in the right hepatic lobe and free fluid in the pelvis. 

On ultrasound, there is a single well defined lesion in the right hepatic lobe with internal echoes and close to the gallbladder. Free fluid was noted in the pelvis (not shown).

Non-contrast CT scan the hypodense lesion was detected in liver parenchyma.

CT shows that the lesion is enhanced with contrast and is suggestive of a hepatic abscess.

CT also shows an appendicolith and signs of appendicular abscess.

3 days later CT scan shows the abscess with the percutaneous pigtail catheter inside the lesion.

Pigtail catheter is placed inside the liver abscess with guided CT scan. 150 mL of purulent material was obtained.

Percutaneous drainage was performed and the diagnosis was confirmed. No surgery was necessary for treatment of the appendicular phlegmon.

Case Discussion

Pyogenic liver abscesses may result from an unchecked acute appendicitis or an appendiceal phlegmon when the infection invades the portal vein (pylephlebitis). 

Liver abscess has a classic triad of fever, right upper quadrant pain and jaundice.

Antibiotical treatment and percutaneous drainage can improve the pathology and is not necessary for any surgical procedure in some cases.

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.