Presentation
Day 7 post laparoscopic cholecystectomy with slow recovery. Worsening SOB and abdominal pain. Deranged LFTs.
Patient Data
Airspace opacification in the right lower zone with loss of both the right heart border and right hemidiaphragm.
Right upper quadrant large lucency with an air-fluid level projected over the liver.
Note normal position of gastric bubble on the left.
Case Discussion
The patient underwent a CT scan in portal venous phase (images unfortunately not available) which confirmed a large subcapsular abscess in segments V and VI of the liver in the gallbladder fossa containing mixed-density fluid and gas.
A US-guided pigtail catheter was inserted later the same day which drained over 100 mL of purulent material. Culture grew E. coli. IV antibiotics were commenced and over 4 days the patient improved.
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