A rare view: giant liver abscess with underlying liver metastases

Description 

Liver abscess (LA) refers to a suppurated cavity caused by the invasion of liver parenchyma, most commonly by Gram-negative  bacteria. Although rare, it is potentially life-threatening. Giant LA (>10 cm) is even more uncommon.1 Symptoms and signs are non-specific and the diagnosis relies essentially on imaging with ultrasound (US) and CT scan. Treatment is based on antimicrobials, abscess drainage and approach to the underlying disease.2 For pyogenic LA, prompt initiation of empirical broad-spectrum intravenous antibiotics,2 usually a third-generation cephalosporin plus metronidazole, is essential with subsequent adjustment to culture and sensitivity, usually for 10–14 days, depending on clinical and radiological response. Together with CT scan or US-guided percutaneous catheter drainage (PD), it is the initial treatment of choice.1 However, large LA >5 cm predicts failure of PD and the need for surgical drainage.3 Malignancy and multiloculation are also risk factors for therapy...

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