PMC7724380_01
Baseline contrast-enhanced CT from previous admission 2 years ago demonstrates mild intrahepatic biliary dilation (arrow) and no evidence of hepatic abscess.
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Follow-up CT showed resolution of the abscess and mild residual intrahepatic duct dilation (Fig. 1).
Contrast-enhanced CT of the abdomen from the current presentation (a) shows multiple new fluid attenuation structures within the liver parenchyma, most consistent with hepatic abscesses (arrows). There is also increased intrahepatic biliary dilation (circle). Narrowing the windows for evaluation of the liver parenchyma (b) better demonstrates ill-defined hypo-enhancing parenchyma around the cystic structures, supportive of abscesses and not simple cysts (arrows). A more inferior slice (c) demonstrates central intrahepatic biliary dilation (arrow). Smaller scattered hypodense foci are in keeping with smaller abscesses. An image at the level of the common bile duct (d) demonstrates an ovoid intraluminal hyperdense filling defect (arrow), confirmed as choledocholithiasis on ERCP.
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Since there was limited availability of ultrasound imaging overnight, a contrast-enhanced abdominal CT was performed (Fig. 2).
ERCP image shows dilatation of the common bile duct, which contains a filling defect in keeping with choledocholithiasis (arrow). There is contrast opacification up to the level of the common hepatic duct.
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ERCP was performed, with removal of a stone and placement of a plastic endobiliary stent (Fig. 3).
Post-ERCP CT shows resolution of the CBD filling defect and associated dilation. However, the common bile duct demonstrates diffuse edematous wall thickening, consistent with cholangitis (arrows).
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However, there was diffuse edematous wall thickening of the CBD, consistent with cholangitis (Fig. 4).
Follow-up CT one month later shows significant decrease in size of the hepatic abscesses (arrows) and only mild residual intrahepatic biliary dilation (circle).
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Follow-up CT one month later showed significant improvement in the hepatic abscesses on continued antibiotic therapy, with only mild residual intrahepatic biliary dilation (Fig. 5).