Presentation
Abdominal pain and fever.
Patient Data
Large liver mass in the anterior right hepatic lobe, involving segments 8, 5, and 4, with central low-attenuation, peripheral irregular rind-like enhancement, and surrounding hepatic parenchymal oedema. There is thrombosis of the middle hepatic vein leading into and coursing along the posterior inferior margin of this mass, with a small amount of clot leading into the inferior cavoatrial junction. There is a similar mass in hepatic segment 7, slightly smaller. Some generalised heterogeneous/diminished perfusion in the segment supplied by the thrombosed middle hepatic vein. There is focal fat along the falciform ligament. No other intra-abdominal abnormalities.
Ultrasound images demonstrate the correlate for the mass, with similar hypoechoic centre, peripheral rind, and parenchymal oedema. These images were obtained as part of a guided percutaneous drainage of the liver abscess.
Case Discussion
Liver abscesses can be unexpected and challenging to diagnose and have a variety of appearances. Though in this setting, the relatively low attenuation centre, 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!
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