His Chest X ray is shown below:
Case Discussion: It is important to look at the “blind areas” of the Chest X ray in order not to miss important clues. These areas are under the diaphragm, behind the heart, the hilum, and the soft tissues. This Chest X ray shows a lucency over the liver density. The lucency does not conform to the usual bowel configuration. In this clinical context, an important differential diagnosis to be considered is a ruptured liver abscess. This can be confirmed either by bedside ultrasound or CT,
A CT scan was done in this patient which is shown below:
Liver abscesses are usually due to organisms like Klebsiella or Amoebiasis. All patients with Klebsiella bacteremia of unknown origin should have imaging studies of the abdomen to rule
out a liver abscess.
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