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• W2912608176 abstract "Introduction: Hepatic microabscesses (MA) may have several etiologies, which may sometimes be difficult to identify. We present an interesting case of hepatic MA in a female, with ambiguous source. Case: A 61 year old female, with history of diabetes mellitus initially presented with chest pain. Acute coronary syndrome and aortic dissection were ruled out. Liver chemistry showed alanine aminotransferase (ALT) 66, and aspartate aminotransferase (AST) 120, other tests were unremarkable. The next day she had epigastric pain, and her ALT/AST increased to 274 and 225 respectively. Physical exam revealed right upper quadrant tenderness. She now had leukocytosis, elevated total bilirubin of 1.4, and normal alkaline phosphatase level. Ultrasound abdomen was suggestive of possible acute cholecystitis, without evidence of cholelithiasis. She was started on intravenous antibiotics for acute acalculous cholecystitis. MRCP showed multiple hepatic MA, thickened gall bladder (GB), with no biliary duct dilation. Patient deteriorated clinically and developed septic shock requiring admission to critical care unit. Her symptoms remained elusive, however she responded to conservative management. Repeat MRI abdomen showed perforated GB and new pericholecystic abscess. Serial blood cultures since admission showed no growth. Cholecystostomy tube was placed by interventional radiology. Repeat CT imaging prior to discharge showed regression of MA. Patient was discharged on oral antibiotics with close follow up and elective cholecystectomy as outpatient. Discussion: Hepatic MA may have multifactorial causes, such as hematogenous dissemination, direct seeding from surrounding source, or ascending cholangitis. Immunocompromised patients are at increased risk. Although hepatic abscess is a known rare complication of perforated gall bladder but reports of microabscesses in relation with acute acalculous cholecysitis have not been well established in literature. We believe our patient's hepatic MA were most likely secondary to direct seeding from acute acalculous cholecystitis. Although hematogenous spread is another possibility, however her stable clinical presentation initially and negative blood cultures make this less likely. Ultrasound, contrast enhanced CT and MRI are useful in diagnosing hepatic MA. Treatment includes antibiotics; percutaneous drainage of GB/liver abscess and serial imaging.Figure: Initial MRI showing multiple hepatic microabscesses.Figure: Repeat MRI six days later showing perforated gall bladder with thickened wall.Figure: Repeat MRI six days later with worsening of microabscesses." @default.
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• W2912608176 date "2017-10-01" @default.
• W2912608176 modified "2023-10-16" @default.
• W2912608176 title "An Interesting Case of Hepatic Microabscesses With a Puzzling Source" @default.
• W2912608176 doi "https://doi.org/10.14309/00000434-201710001-01405" @default.
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