PMC9968402_01
Chest radiograph with large right pleural effusion.
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FIG1
Chest radiograph revealed a large pleural effusion on the right (Figure 1).
Axial CT with contrast showing large right pleural effusion and adjacent atelectasis.
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FIG2
CT of the chest with contrast demonstrated a large right pleural effusion, a 14.2 cm well-defined hypodense lesion in the right liver lobe, pericholecystitis, and cholelithiasis (Figures 2-4). 
Axial CT with contrast showing 14.2 cm well-defined hypodense lesion in the right liver lobe.
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FIG3
CT of the chest with contrast demonstrated a large right pleural effusion, a 14.2 cm well-defined hypodense lesion in the right liver lobe, pericholecystitis, and cholelithiasis (Figures 2-4). 
Axial CT with contrast showing pericholecystic fat stranding (green arrow) and cholelithiasis (red arrow).
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FIG4
CT of the chest with contrast demonstrated a large right pleural effusion, a 14.2 cm well-defined hypodense lesion in the right liver lobe, pericholecystitis, and cholelithiasis (Figures 2-4). 
Ultrasound showing well-defined right hepatic lesion with heterogenous echogenicity with thick internal septations.
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FIG5
Triple-phase liver CT with hypodense right hepatic lobe lesion with ring enhancement on the late arterial phase.
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FIG6
On the late arterial phase, the lesion showcased ring enhancement (Figure 6), favoring abscess.
Normal HIDA scan.. HIDA, hepatobiliary iminodiacetic acid
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FIG7
HIDA scan revealed gallbladder activity and no bile duct obstruction (Figure 7).
Ultrasound-guided needle aspiration and drain placement of hepatic abscess.
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FIG8
Interventional radiology successfully placed a hepatic abscess drain via ultrasound guidance on hospital day 9 (Figure 8).
Liver fluid aspirate - H&E stain 60x magnification showing inflammatory cells (neutrophils, lymphocytes, macrophages, and debris), diagnostic of pyogenic abscess.
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FIG9
The liver fluid aspirate histopathology was consistent with a pyogenic abscess (Figure 9).
Markedly reduced size of pyogenic hepatic abscess with drain in place.
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FIG10
Repeat CT showed improvement in the size of the hepatic abscess (Figure 10).