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Age: 47

Sex: Male

Indication: Right upper quadrant pain, fever

Sonographic Murphy sign: Negative

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Case #3


Findings

  • Heterogeneous hypoechoic lesion in the periphery of the right hepatic lobe measuring up to 5.5 cm without internal vascularity
  • Hepatomegaly with coarsened hepatic parenchymal echotexture
  • No cholelithiasis, gallbladder distension, or gallbladder wall thickening
  • No biliary duct dilation
  • Normal appearance of the right kidney without hydronephrosis
  • Small volume, heterogeneous appearing perihepatic fluid
  • Right pleural effusion


Diagnosis

Hepatic abscess

Sample Report

Heterogeneous hypoechoic lesion in the periphery of the right hepatic lobe measuring up to 5.5 cm without internal vascularity, concerning for an abscess. Adjacent small volume complex ascites raises concern for intraperitoneal rupture.

Hepatomegaly with coarsened hepatic parenchymal echotexture, concerning for cirrhosis.

No cholelithiasis or evidence of acute cholecystitis.

Right pleural effusion.


Discussion

  • Pyogenic hepatic abscesses have many potential etiologies, including:
    • Direct spread from adjacent infection (e.g. gangrenous cholecystitis) or external introduction of infection (e.g. penetrating trauma)
    • Biliary spread from ascending cholangitis
    • Hematogenous spread (particularly from GI infections)
  • Depending on the internal contents, abscesses may appear predominantly hyper- or hypoechoic and may mimic solid liver masses
  • Abscesses should not have internal vascularity (but remember that necrotic neoplasms may not have internal vascularity either)
  • Watch out for associated complications including rupture into the peritoneal cavity and venous thrombosis


Images

Ill-defined hypoechoic structure in the periphery of the right hepatic lobe (red arrows) concerning for a hepatic abscess. Adjacent complex fluid collection (red arrows) concerning for intraperitoneal extension of infection.

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