Unexpected source of fever: Liver abscess on point-of-care ultrasound

Abstract

A previously healthy 58-year-old male presented to the emergency department with a 1-week history of fever and abdominal pain. Initial laboratory investigations demonstrated an elevated white blood cell count and transaminasemia. Point-of-care ultrasound (POCUS) was performed to assess for gallbladder pathology; it unexpectedly identified a 7 cm × 6 cm × 6 cm heterogeneous mass within the liver (Figure 1, Supplementary Video 1). A subsequent computed tomography scan suggested the mass to be a liver abscess (Figure 2A and 2B). It was later percutaneously aspirated under ultrasound guidance and grew Klebsiella pneumoniae. The patient was successfully treated with a 6-week course of intravenous ceftriaxone. Liver abscesses appear primarily hypoechoic with some internal echoes on ultrasound. However, they may also be hyperechoic or have a solid appearance resembling a hepatic tumor. 1

Ultrasonido en el punto de atención: reporte de un caso de absceso hepático

“…Otros casos de diagnóstico por ecografía en el punto de atención de esta condición han sido previamente reportados. [6][7][8] El resultado de esta evaluación permitió dirigir el tratamiento y asegurar una evolución favorable, a pesar de la severidad del cuadro y ante la falta de síntomas y signos clínicos específicos. Se debe destacar que el caso descrito previamente tuvo una presentación inusual, ya que su diagnóstico fue incidental y las manifestaciones que se presentaron al inicio fueron erróneamente atribuidas a una infección del tracto urinario complicada.…”

Point‐of‐care ultrasound diagnosis of a pyogenic liver abscess in the emergency department

“…1,7 There is a notable scarcity of literature describing emergency physician-performed POCUS to identify PLAs. [8][9][10] This case report highlights the critical role of emergency physician-performed POCUS for the early ED diagnosis of the rare but potentially life-threatening condition of PLA.…”