Ultrasound
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This image demonstrates a view of the right upper quadrant using the 2.5 MHz curvilinear probe just below the costal margin. The liver is moderately echoic and takes up most of the image. The abscess has an anechoic/hypoechoic center with a slightly hyperechoic surrounding rim. The diaphragm is very hyperechoic and separates the liver in the near field (top of image) from the lung in the far field (bottom left of image). The right kidney cannot be seen in this image, but is nearby.

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Liver abscesses may be caused by a variety of organisms. Pyogenic abscesses cause about 80% of cases and are often polymicrobial with E. coli or Klebsiella pneumonia being the primary pathogen. Entamoeba histolytica causes about 10% of cases and Candida albicans or another fungal organism is the usual cause in the remaining 10%. Treatment usually entails antimicrobials targeted at the suspected organism or organisms and drainage, often performed percutaneously.

Your patient is admitted to the hospital overnight for antibiotics and antiparasitics. In the morning he is improved and is discharged so that he can get himself to the closest urban hospital where they perform a CT guided drainage of the abscess. The cultures grow out Klebsiella pneumoniae.

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