PMC9827024_01
Chest X ray demonstrates bilateral airspace opacities and well-defined rounded lucency in the liver.
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Radiological evaluation with a chest x-ray revealed bilateral patchy air space opacities and a well-defined rounded heterogenous hepatic lucency (Fig. 1).
Abdominal CT demonstrates an abscess 8 cm in diameter in the right liver lobe and air tracking along the hepatic vein.
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Hepatic pathology was confirmed with an abdominal ultrasonography (US) and a computed tomography (CT) scan that demonstrated a significant right lobe liver abscess 8 cm in diameter with a gaseous core replacing normal hepatic parenchyma and an air fluid levels as well as focal emphysematous air tracking into adjacent hepatic veins (Fig. 2).
CT pulmonary angiography demonstrates bilateral pleural effusions and filling defects in the right lower lobe pulmonary artery division as well as scattered pulmonary nodules and irregular airspace infiltrates of varying sizes.
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An urgent CT pulmonary angiography (CTPA) revealed bilateral pleural effusions and filling defects in the right lower lobe of the pulmonary artery denoting probable septic emboli (Fig. 3).
A and B PET CT FDG uptake scan demonstrates a large lesion in the right liver lobe segment VII, VIII measuring 7 cm by 7.5 cm with increased FDG uptake along its peripheral thick wall with air locules seen within the lesion.
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There were no other sites with pathologic FDG uptake (Figs. 4 and 5).
A and B PET CT FDG uptake scan demonstrates an ill-defined collection with peripheral increased FDG uptake and central necrosis, involving gluteus maximus, gluteus medius, and minimus, measuring 15 cm by 8 cm by 15 cm in maximal dimensions. There is also a focal area of fat stranding in the subcutaneous fat of the right gluteal region with peripheral FDG uptake measuring about 5 cm by 3.3 cm by 10 cm in maximal dimensions.
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There were no other sites with pathologic FDG uptake (Figs. 4 and 5).