Pleural Empyema as a Complication of Pyogenic Liver Abscess: Can the Minimum Achieve the Optimal? A Comparison of 3 Approaches

Transdiaphragmatic sarcomatoid carcinoma of the lung: A case report

INTRODUCTION

Pulmonary sarcomatoid carcinoma is a very rare primary tumor of the lung. Although usually aggressive, these tumors have not been described previously to invade through the diaphragm into the liver. We present a patient with a pulmonary sarcomatoid carcinoma with transdiaphragmatic spread into the dome of the liver.

PRESENTATION OF CASE

An 82-year-old female with a lifetime non-smoking history presented with generalized fatigue, fever, night sweats, cough, and pleuritic chest pain. She had recently traveled to the western United States. Additionally, she had recently undergone periodontal deep cleaning with no peri-procedural antibiotics. Laboratory testing was significant for a leukocytosis of 13.5 white blood cells per microliter and a negative viral panel. Computed tomography and magnetic resonance imaging revealed a large heterogeneous mass extending from the right pulmonary hilum through the diaphragm. Although initial radiology reports suggested hepatic abscess, percutaneous fine needle aspiration was performed. Biopsy revealed pulmonary sarcomatoid carcinoma. She was begun on systemic treatment.

DISCUSSION

Pulmonary sarcomatoid carcinoma can exhibit transdiaphragmatic invasion into the liver. This clinical situation can easily be confused with a hepatic abscess, but suspicion should remain for abscess. Clinical suspicion for neoplasm should warrant biopsy when technically possible.

CONCLUSION

Although hepatic abscesses can exhibit transdiaphragmatic spread into the chest, pulmonary sarcomatoid carcinoma can also invade the abdomen. Biopsy should be performed during the evaluation and workup of the patient.

Pasteurella multocida bacteraemia with liver abscess

A previously healthy woman in her mid-70s presented with right upper quadrant abdominal pain, fever, intermittent chills and malaise for 1 week. She was clinically septic with raised inflammatory markers. Her blood culture revealed Pasteurella multocida, which was susceptible to penicillin and amoxicillin-clavulanic acid. CT of liver revealed an abscess of 8.0×7.9×8.5 cm at the left lobe of the liver. However, the abscess was not amenable for surgical or radiological drainage. She was a farmer and had close contact with her pet cats. She was occasionally scratched by her cats when caring for them. The liver abscess resolved completely without drainage after prolonged antimicrobial therapy of 109 days. She commenced on 63 days of intravenous antimicrobials and 46 days of oral amoxicillin-clavulanic acid. This case illustrated P. multocida bacteraemia with a large liver abscess in an immunocompetent adult after non-bite exposure.

Hepatic Abscess in Inflammatory Bowel Disease: A Systematic Scoping Review of an Overlooked Entity

Background

Liver abscess is one of the hepatobiliary manifestations of inflammatory bowel disease (IBD) that has been scarcely described in the literature.

Objectives

To conduct a scoping review to provide a detailed description of the occurrence of hepatic abscess in patients with IBD and summarize the observed clinical features.

Methodology

Searches were carried out using relevant keywords in Medline (via PubMed) and Web of Science from inception until June 13, 2022. Only articles that reported the occurrence of hepatic abscess in patients with IBD were included.

Results

Forty-eight publications (40 case reports and 8 case series) were included, representing 73 patients with IBD who were radiologically or intraoperatively diagnosed with hepatic abscess. Patients with Crohn's disease were more predisposed to developing hepatic abscess than patients with ulcerative colitis (79.5% vs. 20.5%, respectively). Furthermore, pyogenic liver abscess was found to be more prevalent (57.9%) compared with aseptic (38.7%) and amebic (3.2%) abscesses. No clear relation was found between death or prolonged hospital stay in terms of the clinical presentation or management plan, as mortality was reported in different age groups with different managements.

Conclusion

To date, there is no consensus regarding the appropriate management of hepatic abscess as an extraintestinal manifestation of IBD. However, the condition shares several features with liver abscess diagnosed among the general population.

Empyema after image-guided percutaneous intercostal drainage of subdiaphragmatic collection: a case series

Background

Treatment of subdiaphragmatic collection by intercostal image-guided drain placement is associated with a risk of pleural complications including potentially life-threatening pleural empyema. Descriptions of patient characteristics and clinical course of postinterventional pleural empyema are lacking. We aim to present characteristics, clinical course and outcomes of patients with empyema after intercostal approach of drain placement.

Methods

Data was collected as a retrospective single center case series and included adult patients with decortication for treatment of pleural empyema after image-guided percutaneous intercostal drainage of a subdiaphragmatic collection between 01.01.2009 and 31.01.2021.

Results

We identified ten patients, nine male and one female, all suffering from subdiaphragmatic collection treated with intercostal drain. All patients developed pleural empyema after drain placement and received surgical decortication. Similarities between patients were drain placement under computed tomography (CT)-guidance (eight of ten patients), lateral position of the drain (seven of ten patients), drain insertion in the eighth intercostal space (ICS) (six of ten patients) and existing comorbidities as malnutrition (six of ten patients), diabetes (four of ten patients) and cancer (three of ten patients). The majority of patients had a prolonged length of hospital stay (LOS) with an average duration of 40 days. Nearly half of the patients needed intensive care unit (ICU) treatment and one patient died postoperatively from respiratory exhaustion.

Conclusions

In this series, empyema after intercostal drainage was associated with prolonged LOS and was potentially life-threatening. The most commonly shared features in our cohort were the high prevalence of comorbidities, drain insertion above ninth ICS as well as lateral position of the drain. These factors should be addressed in prospective studies to evaluate potential correlation with postinterventional empyema. For optimal management of patients with subdiaphragmatic collection treated by intercostal drainage, awareness of potential associated complications is crucial.

Streptococcus intermedius Bacteremia and Pyogenic Liver Abscess in a Patient With No Risk Factors

This case report depicts a 39-year-old male with no significant past medical history who was admitted for fever of unknown origin and sepsis. He was then found to have Streptococcus intermedius bacteremia and pyogenic liver abscess. The treatment course was complicated by pleural empyema leading to readmission. The case presented here adds to the medical literature, where a clear underrepresentation has been noted, and outlines a unique case of S. intermedius liver abscess complicated by pleural empyema in a patient without significant medical history, risk factors, or typical physical exam findings.