PMC9290080_01
Images of CT, MRCP, and ultrasound at presentation. (a, b) CT and MRCP revealed choledocholithiasis with a gallstone in the distal part of the common bile duct. (c) Abscess of the LTH was not detected at the first visit. (d, e) T2WI showed a lesion with a mixed-signal intensity that extended from the median fissure of the liver to the lower abdomen. (f, g) Combined diffusion-weighted imaging (DWI) sequences showed increased signal intensity and restricted diffusion. The white arrows indicate the lesion in D-G. (h) Postoperative abdominal CT revealed an irregularly shaped low-density lesion in the upper/middle abdomen, confirming the persistent abscess. The white arrow indicates the drain tube attached to the abscess wall, suggesting insufficient pus drainage. (i) Ultrasound-guided abscess drainage was followed. The white arrow indicates the puncture needle. The white asterisk indicates the abscess cavity in H and I. (j) Doppler ultrasound showed that the abscess cavity had completely disappeared 2 weeks after discharge.
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A computational tomography (CT) scan of the upper abdomen and magnetic resonance cholangiopancreatography (MRCP) revealed gallstones and choledocholithiasis with a 5.0-mm stone in the distal part of the common bile duct, leading to dilation of the intrahepatic and extrahepatic biliary duct (Figure 1(a) and (b)). A thorough retrospective examination on CT scans was conducted, although this LTH abscess was absent in the imaging at the first admission (Figure 1(c)). T2-weighted imaging (T2WI) that extended from the median fissure of the liver to the lower abdomen (Figure 1(d) and (e)). The combined diffusion-weighted imaging (DWI) sequence showed high signal intensity and restricted diffusion (Figure 1(f) and (g)), representing the LTH abscess. However, a subsequent CT scan detected the persistent abscess, which appeared to be a draining tube attached to the wall, suggesting that the draining of the pus was insufficient (Figure 1(h)). Ultrasound-guided pus aspiration was followed immediately (Figure 1(i)). Doppler ultrasound showed that the abscess cavity had completely disappeared 2 weeks after discharge (Figure 1(g)).