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Monday, June 19, 2017

Ruptured Liver Abscess.

A 50-year-old male presented to the Emergency Room with shock and a four-day history of a febrile illness. He required intubation and was started on inotropes.
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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