PMC4408944_01
Abdominal CT findings on admission.. Notes: Plain CT scans show hypodense masses with poorly defined margin in the periphery of right anterior and posterior segments of liver (A and B). Arterial phase (30 seconds) dynamic contrast-enhanced CT scans show double-target sign consisting of a central cystic area with an inner enhanced rim and an outer hypodense zone in anterior and posterior segments of right lobe, and also left lobe (C and D). Portal phase (90 seconds) dynamic CT scans show thick rim enhancement (E and F). Late phase dynamic contrast-enhanced CT scan of the pelvic region shows a thick hyper-enhanced wall in the appendix (G). Arrow head denotes appendix.. Abbreviation: CT, computed tomography.
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The masses ranged in size from 1 cm to 3 cm, and were hypodense with irregular margins, strongly suggestive of liver abscesses (Figure 1A-F). Moreover, CT imaging showed a thick, hyper-enhanced wall and adjacent fat stranding in the appendix (Figure 1G).
The course of liver abscess depicted on CT.. Notes: 8 Fr pigtail catheters for percutaneous drainage are placed in segments VI and VIII (A and B). Right pleural effusion and empyema are evident (C). 8 Fr pigtail catheters have been changed to 12 Fr or14 Fr large-bored catheters, and a 8 Fr pigtail catheter is placed in segmental VII (D and E). An intraperitoneal abscess is observed (F). Percutaneous catheter drainage has been removed from segment II after the patient's clinical condition and laboratory test results improved (G and H). Percutaneous catheter drainage is restarted to drain hepatic abscesses; 12 or 14 Fr large-bored catheters for segments IV, VI and VII, and 8F-pigtail catheters for segments II and VIII (I and J). CT scans show hypodense mass with well-defined margin at periphery of right anterior and posterior segment, and left segment of liver (K and L). These findings show resolved abscess formation. The abscesses seen at admission have resolved.. Abbreviation: CT, computed tomography.
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Two 8 Fr pigtail catheters placed in segments VI and VIII yielded thick tenacious pus (Figure 2A and B). An abdominal CT scan showed further spread of abscesses in segments II, IV, VI, VII and VIII of the liver and in the subphrenic space (Figure 2A and B). Then, right pleural effusion and empyema (Figure 2C) with clinical features of respiratory failure appeared after the twentieth day. An additional 8 Fr pigtail catheter was placed into segmental VII on the patient's thirtieth day in hospital (Figure 2D and E). Surprisingly, on the patient's thirtieth day in hospital, an intraperitoneal abscess was noted and 30 mL of turbid pus was aspirated from the peritoneal cavity (Figure 2F). However, CT scans showed gradual enlargement of abscesses in segments II, VII and VIII of the liver (Figure 2G-J) on days 40-50. Abdominal CT repeated on the patient's one-hundredth day in hospital showed resolution of the previously described masses (Figure 2K and L) and the patient's clinical condition improved gradually (Figure 4).
Abscessogram of segmental VI.. Note: A colobiliary fistula is visible. R denotes the right side.
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A colobiliary fistula with a liver abscess was detected by PCD catheter (Figure 3).
Clinical course (A) and diagrams of percutaneous drainage (B).. Abbreviations: CPZ, cefoperazone; MPN, meropenem; LVFX, levofloxacin; LNZD, linezolid; TMT-SMX, trimethoprim-sulfamethoxazole; INN, fosfluconazole; ALT (GPT), alanine aminotransferase (glutamic pyruvic transaminase); CRP, C-reactive protein.
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Abdominal CT repeated on the patient's one-hundredth day in hospital showed resolution of the previously described masses (Figure 2K and L) and the patient's clinical condition improved gradually (Figure 4).