Case #2

• Lower chest
  • Mild cardiomegaly
  • Mild dependent atelectasis
• Abdomen/Pelvis
  • Large fluid density structure in hepatic segments 7 and 8 measuring 10 x 7 x 7 cm with internal septation and circumferential ill-defined low density compatible with edema
  • Peripherally enhancing subcapsular collections along the anterior margin of the left hepatic lobe measuring 3 x 1 cm and 2 x 1 cm
  • Clearly marginated fluid density structure in segment 7 and several other scattered tiny hypodensities, which likely represent cysts
  • Mild mural thickening of a segment of the sigmoid colon with adjacent fat stranding and a 1.5 cm fluid and gas collection along the tip of an inflamed diverticulum
  • Loss of the normal fat plane between this collection and adjacent loops of small bowel, which demonstrate mural thickening
  • No bowel obstruction
  • High grade stenosis of the left common iliac artery, with the left internal and external iliac arteries remaining patent
  • Incidental splenule
• MSK
  • No acute findings
  • Ankylosis of both sacroiliac joints
  • Circumscribed sclerotic lesion in the left anterolateral seventh rib without aggressive features, likely a bone island

• Hepatic abscess

• Pyogenic hepatic abscesses have many potential etiologies, including:
  • Direct spread from adjacent infection (e.g. gangrenous cholecystitis) or external introduction of infection (e.g. penetrating trauma)
  • Biliary spread from ascending cholangitis
  • Hematogenous spread (particularly from GI infections, as in this case)
• The classic CT imaging appearance is a double target sign with internal low density surrounded by an internal enhancing rim (capsule) and a low density external rim (edema)
• Abscesses may be unilocular or multilocular
• Gas is present in a minority of cases
• Unfortunately, necrotic tumors can have an overlapping imaging appearance, so it is important to follow these to resolution

Images