Liver abscess

Abstract

A 54-year-old man presented with epigastric pain of 4 weeks' duration. There was tenderness to palpation in the epigastrium. EGD revealed an erosion with surrounding submucosal edema on the lesser curve of the mid gastric body (A, arrow). The patient was hospitalized the next day because of fever (39.3°C). The white blood cell count was 13.0×109/L (normal: 4-9×109/L), and total bilirubin was 3.6 mg/dL (0.2-1.2 mg/dL). US demonstrated a 2×3×4-cm hypoechoic lesion with an associated linear hyperechoic structure 1.5 cm in length in the left lateral segment of the liver (B, arrow). CT confirmed the diagnosis of liver abscess associated with a linear calcified foreign body (C, arrow). After US-guided percutaneous drainage of the abscess, imipenem/cilastatin were administered intravenously. Culture of the abscess fluid grew Streptococcus constellatus. The patient became afebrile, but US still demonstrated the foreign body. At laparotomy, the abscess was resected and was found to contain a 10-mm foreign body, consistent with a fish bone (D). The patient, who recovered uneventfully, recalled that he had eaten small fish whole a month earlier. View Large Image Figure Viewer View Large Image Figure Viewer View Large Image Figure Viewer