Point‐of‐care ultrasound diagnosis of a pyogenic liver abscess in the emergency department

Abstract

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Point‑of‑care ultrasound for the diagnosis of liver abscess in a patient with HIV in the emergency department: A case report

“…as observed in the patient presented herein, the majority of cases are observed in males, between the third and sixth decade of life. the etiology of liver abscess is multifactorial and is related to predisposing factors (1,6). the associated risk factors increase the presence of liver abscesses in individuals with oncological diseases, diabetes mellitus, immunosuppression, alcoholism and local factors, such as biliary causes (history of hepatobiliary surgery, chronic obstruction of the bile ducts), portal causes (chronic infectious focus drained by the portal) and the superimposition of pre-existing lesions (cyst and necrotic hepatic metastasis) (9,10).…”

“…It was decided to perform PoCUS (loGIQ e, GE Healthcare) following previously established protocols (6). a hypodense intrahepatic image was observed between segments VII and VI, with internal echoes suggestive of a liver abscess (Fig.…”

“…on the same day, radiology and general surgery were consulted. It was decided to perform tomography-guided percutaneous drainage of the liver abscess (IQon Spectral Ct, Philips) following formerly recognized protocols (6). a 230 cc drainage was obtained, with no complications (Figs.…”

“…Furthermore, PoCUS presents a sensitivity between 85-92% (4,5). to date, reported literature on the use of PoCUS for the early detection of liver abscesses is limited; the lack of training in its management by clinical staff in emergency services has also been described, an issue that is still challenging for the physician due to the scarcity of symptoms and signs (6,7). Moreover, in human immunodeficiency virus (HIV)-positive patients, the usefulness of PoCUS is of utmost importance as a tool for the exclusion of other differential diagnoses, or common opportunistic infections in this population, concerns that can delay diagnosis and subsequent treatment.…”

Multiorgan Point-of-Care Ultrasound Assessment in Critically Ill Adults

“… 38 , 39 The exam may also support more severe infections like cholangitis with the presence of a dilated common bile duct. 40 Other pathologies which may be evident on abdominal ultrasound include appendicitis, 41 diverticulitis, 42 liver abscess, 43 or portal venous gas 44 ; a more advanced skill set is required for any of these diagnoses, and POCUS is generally considered inferior to CT imaging here. Given the frequency of urinary sources of sepsis, renal applications should not be ignored.…”