Tran Melanie, Tran Patrick
Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
BMJ Case Rep. 2023 Apr 25;16(4):e254474. doi: 10.1136/bcr-2022-254474.
Pyogenic liver abscess (PLA) commonly occurs in the right liver lobe, causing the typical symptoms of fever and right upper quadrant pain. Less than one-third of cases occur in the left lobe. We describe an unusual presentation of a giant left-sided PLA that was compressing the stomach and surrounding venous vasculature, causing the respective symptoms of gastro-oesophageal reflux and vaginal discharge from secondary pelvic congestion syndrome. CT revealed a solitary 14 cm×10 cm×10 cm multiloculated lesion, replacing most of the left liver lobe. It was successfully treated with intravenous antibiotics and percutaneous drainage, resulting in complete resolution at 1-year follow-up. This case explores the predisposing risk factor of diabetes in PLA and its association with which was the offending pathogen in our patient. We also discuss the phenomenon of secondary pelvic venous congestion syndrome and compare similar cases of left-sided PLA, highlighting the different modes of presentation and treatment options.
化脓性肝脓肿（PLA）通常发生在肝右叶，引起发热和右上腹疼痛等典型症状。不到三分之一的病例发生在左叶。我们描述了一例罕见的巨大左侧PLA病例，该脓肿压迫胃部和周围静脉血管，导致胃食管反流和继发性盆腔充血综合征引起的阴道分泌物等相应症状。CT显示一个孤立的14 cm×10 cm×10 cm多房性病变，占据了大部分左肝叶。通过静脉注射抗生素和经皮引流成功治疗，在1年随访时完全消退。本病例探讨了PLA中糖尿病的易感危险因素及其与我们患者体内致病病原体的关联。我们还讨论了继发性盆腔静脉充血综合征的现象，并比较了左侧PLA的类似病例，强调了不同的表现方式和治疗选择。
