Liver abscesses with venous extension - rare complication of a common problem

Abstract

Considering the high incidence of amoebic and pyogenic liver abscess in the developing world, occurrence of inferior vena cava thrombosis secondary to liver abscess is a rare but life threatening complication. We report 4 such complicated cases of liver abscess(s). The first case involved a large caudate lobe abscess extending across middle hepatic vein into suprahepatic inferior vena cava (IVC). Development of a left hepatic artery pseudoaneurysm following attempted percutaneous aspiration highlights the difficulties encountered in percutaneous interventional management of caudate lobe abscesses. The second case involved multiple liver abscesses with large thrombus in the right ventricular cavity & right ventricular outflow tract. The patient developed cardiorespiratory arrest limiting any aggressive management options for the complex nature of illness. The third case had a large caudate lobe abscess with direct extension into Intrahepatic IVC while the fourth showed a segment 4 abscess with thrombosis of adjacent left hepatic vein. These cases highlight the fact that diagnosis of such life threatening complications of liver abscesses as hepatic vein & IVC thrombosis requires high clinical suspicion followed by targeted imaging. Image guided interventional therapy is a useful tool for management in cases of liver abscess. But, abscesses in precarious locations like caudate lobe are associated with higher risk of complications including pseudoaneurysm formation asking for a cautious approach to interventional therapy in such circumstances.

Conservative treatment of suprahepatic pseudoaneurysm in a pediatric patient

“…In the differential diagnosis, it is important to rule out the presence of congenital anomalies, such as Abernethy's malformation (5) . The association of IVC pseudoaneurysms with the removal of IVC filters (6) or as a complication of infectious processes (7) has also been described. The literature includes some cases of IVC aneurysms and pseudoaneuryss (1,2) , but no articles that deal specifically with pseudoaneurysms of the suprahepatic veins have been found, as in the case of the patient described in this article, probably because of its rarity.…”

A case of amoebic liver abscess complicated by bilhaemia and venous thrombosis

“…There is scant literature about the prevalence and management of venous thrombosis in an amoebic liver abscess 5. Asymptomatic patients may not need anticoagulation, as management of the abscess per se usually leads to its resolution.…”

“…4 There is scant literature about the prevalence and management of venous thrombosis in an amoebic liver abscess. 5 Asymptomatic patients may not need anticoagulation, as management of the abscess per se usually leads to its resolution. However, short duration anti-coagulation may be considered in patients with caval involvement or those who become symptomatic with portal hypertension or mesenteric ischaemia.…”

“…However, short duration anti-coagulation may be considered in patients with caval involvement or those who become symptomatic with portal hypertension or mesenteric ischaemia. 5…”

A rare case of caudate lobe liver abscess

“…and IVC, making such abscess prone to vascular and biliary complications. 9 Ultrasonography can be useful as a screening tool but CECT is definitive for diagnosis and to rule out complications such as spontaneous rupture and involvement of vasculature. The sensitivity of USG is 80-95% and that of CT scan is found to be 95-100%.…”