Fever, RUQ pain, elevated LFTs, suspected pyogenic liver abscess
Recommended: CT Abdomen with IV contrast or RUQ Ultrasound is the preferred imaging study for fever, ruq pain, elevated lfts, suspected pyogenic liver abscess. Pyogenic (most common), amebic, or fungal.
Recommended study
CT Abdomen with IV contrast or RUQ Ultrasound
Pyogenic (most common), amebic, or fungal. Cluster of small cysts that coalesce.
If the default doesn't apply
Bedside / hemodynamically stable
US
RUQ Ultrasound + percutaneous drainage
No contrast
Suspected amebic
CT
CT + Entamoeba serology
IV contrast
Watch-outs
Klebsiella pneumoniae liver abscess
Endemic in Asia; associated with metastatic infection (endophthalmitis, septic emboli, brain abscess) — image broadly.
Source identification
Look for biliary, portal (diverticulitis, appendicitis), or hematogenous source.
Pearls
- Cluster sign: multiple small abscesses coalescing — pyogenic.
- Double target sign on CT: inner low + middle enhancing + outer low — amebic.
- Percutaneous drainage + empiric antibiotics is standard; surgical drainage for failed PCD.