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Images of Memorable Cases: Case 57

Module by: Herbert L. Fred, MD, Hendrik A. van Dijk. E-mail the authorsEdited By: Frederick Moody

http://rup.rice.edu/memcases-button.jpg

Case_57-pres1-1.jpg

Chest radiograph of a 51-year-old man with fever and shaking chills of two weeks’ duration. His physical examination was unremarkable except for a temperature of 104°F.

The chest radiograph shows a peculiar pattern of mottled gas and an air-fluid level in the region of the liver. On computed tomographic (CT) study of the abdomen, the scout film (below left) shows the gas to be similar in appearance to, but separate from, intestinal gas. The CT scan demonstrates a large liver abscess with an air-fluid level (below right). Drainage of the abscess yielded 600 cc of pus, which grew Klebsiella pneumoniae.

This case illustrates the value of the chest radiograph in diagnosing disease below the diaphragm.

Case_57-diag1-1.jpg Case_57-diag1-2.jpg

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