Infect Chemother.  2012 Oct;44(5):382-385. 10.3947/ic.2012.44.5.382.

A Case of Pyogenic Liver Abscess Complicated by Hepatobronchial Fistula

• Kim SH
• Park SY
• Kim MJ
• Kim J
• Lee SH
• Jeon MH
• Kim HS

• KMID: 2170384
• DOI: http://doi.org/10.3947/ic.2012.44.5.382

Abstract

Hepatobronchial fistula, an anatomic communication between the liver parenchyma and the bronchial tree, is a rare condition, which usually develops as a complication of amoebiasis, hydatid cysts, and trauma. We report on a case of a pyogenic liver abscess complicated by a hepatobronchial fistula, which responded well to treatment with antibiotics and percutaneous drainage. A 36-year-old male patient presented with a two-week history of dry cough, shortness of breath, right side abdominal pain, and fever. Chest computed tomography scan showed a heterogeneously enhanced abscess measuring approximately 6 cm in the right liver dome. Percutaneous drainage was performed and antibiotics were administered against Group C Streptococcus cultured from the abscess. After nine days of therapy, repositioning of the drainage catheter was performed and the patient coughed suddenly during injection of contrast media, and communication from abscess to bronchus was discovered. While maintaining abscess drainage and antibiotic therapy, the fistula diminished gradually and disappeared completely with resolution of the liver abscess.

Keyword

Liver abscess; Pyogenic; Bronchial fistula

MeSH Terms

Abdominal Pain
Abscess
Adult
Amebiasis
Anti-Bacterial Agents
Bronchi
Bronchial Fistula
Catheters
Contrast Media
Cough
Drainage
Dyspnea
Echinococcosis
Fever
Fistula
Humans
Liver
Liver Abscess
Liver Abscess, Pyogenic
Male
Streptococcus
Thorax
Anti-Bacterial Agents
Contrast Media

Figure

• 

  Figure 1 Chest radiograph shows costophrenic angle blunting at the right hemithorax with a small amount of fissural effusion and passive atelectasis in Rt. chest.

• 

  Figure 2 Chest computed tomography shows a huge heterogeneously enhanced mass with multiple septums measuring 5.9 cm×4.9 cm×3.5 cm at the right lobe of liver.

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  Figure 3 (A) Tubogram performed during repositioning of the pigtail catheter shows a fistula between the hepatic abscess and bronchial tree. (B) Follow-up tubogram taken after six weeks shows that the hepatobronchial fistula had disappeared.

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