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Images in paediatrics
Hepatic abscess: presentation in a previously healthy teenager
  1. Robert Mark Hegarty,
  2. Sunil Sanka,
  3. Sanjay Bansal
  1. Paediatric Liver Centre, NHS Foundation Trust, King's College Hospital, London, UK; rhegarty{at}doctors.org.uk
  1. Correspondence to Dr Robert Mark Hegarty, Paediatric Liver Centre, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK; rhegarty{at}doctors.org.uk

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A previously healthy 13-year-old boy presented to his local Accident and Emergency department with a 1 week history of fevers, rigours and a swelling in the right, posterior, lower rib cage. He had been experiencing right sided abdominal pain for 1 month prior to his presentation and had received two courses of oral antibiotics for a suspected lower respiratory tract infection. On examination, the patient was found to have a 12×10 cm, superficial, fluctuant mass extending from the right, posterior, ninth rib to the flank (figure 1). An ultrasound scan showed a 6×6 cm abscess in the right lower lobe of the liver which had breached the capsule and formed a 6 cm subcutaneous abscess. This was confirmed by CT (figure 2). 15 ml of purulent material was obtained by percutaneous aspiration and the culture grew Bacillus cereus. Subsequent tests for granulocyte dysfunction and immunodeficiency were negative and no underlying cause was detected. The patient was treated with 6 weeks of intravenous antibiotics. His most recent ultrasound scan shows successful resolution of the collection.

Figure 1

A large swelling was still present following an aspiration.

Figure 2

CT scan showing a hepatic abscess which has ruptured the capsule and extended into the subcutaneous space (shown by arrowheads).

Liver abscesses in the healthy, paediatric population in developed countries is rare.1 Nonetheless, liver abscess should be considered in the differential diagnosis of children presenting with abdominal complaints associated with fever.2

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Footnotes

  • Contributors RMH wrote the initial draft which was revised by SS and SB.

  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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