Liver Abscess

A pt presented with high fever and abdominal pain. He had elevated transaminases and bilirubin.
CT abdomen revealed lesions in the liver

Same lesion shown in different views

Liver Abscess. Coronal View

Liver Abscess Sagittal View

Liver Abscess Axial View

Aspiration was performed under CT guidance.

Cultures grew Strep Anginosus , sensitive to ceftriaxone. He was treated with ceftriaoxone for several weeks follow by oral therapy. Repeat imaging showed resolution of lesions.

Extensive Dental Caries

A 48 year old man presented with fever. Blood cultures were positive for streptococcus. An echocardiogram revealed a vegetation on mitral valve. Source of initial infection was not clear. He was noted to have poor oral hygiene.
Panorex was ordered which is shown below

Panorex showing Extensive Dental Caries

Panorex showed dental caries as shown by the arrows.

It was concluded that the most likely source of introduction of streptococcus infection is his mouth.

Follow up with his dentist was recommended post discharge.