Ruptured pyogenic liver abscess with secondary empyema thoracis / Jessamine C. Dacanay.

Includes appendices and bibliographical references.

ABSTRACT: This is a case of E.S., 70 y/o female, who came in with difficulty of breathing. Initial impression was massive pleural effusion. Thoracentesis revealed empyema. Hence ultrasound with mapping was done prior to thoracostomy tube insertion, however there was an incidental finding of liver abscess. Thoracostomy tube was inserted, but only with minimal drainage. VATS was suggested but relatives opted for medical management. Empyema may be diagnosed indirectly by chest x-rays, CT, MRI, or definitively by thoracentesis. Treatment of empyema is drainage of fluid by thoracentesis or CTT with suction. IV antibiotic therapy is administered based on pathogen sensitivity. Pyogenic liver abscess is uncommon, accounting for 8 to 25 cases per 100,000 hospital admissions. Klebsiella pneumoniae is the most common pathogen of pyogenic liver abscesses, among Asians, especially in patients with diabetes mellitus As mortality is high in patients with pyogenic abscess, empirical antibiotic therapy should be broad-spectrum. IV and in high doses. Combinations of agents are required to cover the wide range of possible pathogens, penetrate the abscess cavity, and other bactericidal activity.

Research - Department of Medicine