20705              MASSIVE LIVER ABSCESS

The patient was a man aged 76.  The gallbladder had been removed 4 years previously with good result.  On the last occasion he presented with upper abdominal pain, dehydration, vomiting, fever and urinary incontinence.  The B.P. was 230/120 and there was right sided abdominal tenderness without rigidity or guarding.  The liver was palpable 4 cms below the costal margin.  There was leucocytosis of 14,000 and blood culture grew gram-negative organisms.  He was treated with Kanamycin and improved, but a week later was jaundiced with bile in the urine.  Chest X-ray showed consolidation of the right lower lobe and there was marked peripheral cardiac oedema.  He died on the 16th day.  At postmortem there was massive right pleural effusion with collapse of the right lung and purulent effusion with collapse of the right lung and purulent bilateral tracheobronchitis.  The liver was enlarged and was adherent to the diaphragm by dense fibrous adhesions. A large fluctuant area was palpable in the anterior aspect of the right lobe.

The specimen is the liver sectioned to show this abscess which measures 15 cms in diameter.  There is one large cavity 10 cms in diameter and many smaller satellite cavities on its medial aspect.  Many of these satellites apparently communicate with each other.  The remainder of the liver is swollen and pale and there are areas of postmortem gaseous disruption.  Histology shows a thick-walled abscess filled with pus.