CXR in hepatic abscess

Q: All of the following can be diagnostic clues in Chest-X-ray (CXR) in patients with hepatic abscess EXCEPT? (select one)

A) Right basilar atelectasis 

B) Right hemidiaphragm elevation

C) Right pleural effusion

D) Right loculated Pneumothorax (PTX)

E) Pneumobilia

Answer: D

In this era of CT scans, ultrasounds, and MRIs, CXR is usually ignored in hepatic pathologies but when combined with a clinical picture, they can provide valuable indirect signs including basilar atelectasis, hemidiaphragm elevation, and pleural effusion on the right side. Moreover, gas within the abscess or biliary tree (pneumobilia) or beneath the diaphragm can be seen.

Loculated Pneumothorax (PTX) is unlikely (choice D).

#hepatology

#radiology

#pulmonary

References:

1. Kozielewicz DM, Sikorska K, Stalke P. Liver abscesses – from diagnosis to treatment. Clin Exp Hepatol. 2021 Dec;7(4):329–36. doi: 10.5114/ceh.2021.110998. Epub 2021 Nov 26. PMCID: PMC8977881.

2. Crompton JG, Jimenez JM, Chen F, Hines OJ. Man with liver abscess and pneumobilia. Surgery. 2018 Apr;163(4):965-966. doi: 10.1016/j.surg.2017.09.013. Epub 2018 Jan 3. PMID: 29306540.