Pediatric Pyogenic Liver Abscess

  • Etiology:
    — Caused by hematogenous spread from gastrointestinal tract or ascending cholangitis or superinfection of necrotic disease
    — Commonly due to Escherichia coli and Klebsiella pneumoniae
  • Imaging:
    — Single or multiple in number
    — May involve one portion of liver or may be diffuse
    — Vary in size from few milimeters to several centimeters in size
    — May have rim enhancement
    — May contain septations or gas
    — Cluster sign – small pyogenic abscesses coalesce into larger cavity
  • DDX:
  • Complications:
  • Treatment: Usually medical
  • Clinical:
    — Uncommon in children so when seen should think of underlying chronic granulomatous disease
    — Presentation is fever or right-sided abdominal pain or weight loss or elevated liver function tests

Radiology Cases of Pyogenic Liver Abscess

Radiology Cases of Pyogenic Liver Abscess Due to TPNoma

AXR and CT of extravasation of TPN into the liver due to umbilical venous catheter perforation out of the vein
AXR AP shows the tip of the umbilical venous catheter to project over the left portal vein. Axial CT with contrast of the abdomen shows multiple low density lesions which appear to be joined together in the left lobe of the liver.
US of TPNoma
Initial AXR AP (above left) shows the umbilical venous catheter (UVC) tip to project over the liver and not to project at the junction of the inferior vena cava and right atrium. The UVC did not work well and was removed several days later. AXR 2 weeks later (above right) shows interval development of hepatomegaly. Transverse (below left) and sagittal (below right) US of the liver show a large septated and complex fluid collection within the liver.