Fever & Chills for 3 days

60-year-old lady had fever and chills for 3 days.
She also had cough, vomiting and constant RUQ pain.
She had no specific medical condition prior to this visit.
Physical examination: soft abdomen with right CP angle knocking tenderness

In addition to lab tests,
her imaging studies for fever workup include CXR and KUB.

CXR: increased interstitial process and right lower lung atelectasis.

KUB: 2 abnormal gas lesions noted at right upper quadrant
(a teaching film: one film diagnosis)

We do emergency ultrasound at bedside for fever workup.
hyperechoic lesions with dirty shadow were noted within liver parenchyma

Lesions on KUB & CT tomography

Diagnosis: Gas-forming liver abscess (B/C: K.P.)

We used sector transduce and abdomen setting to scan both lesions in a limited intercostal space.

She had undiagnosed diabetes this time. She recovered well after adequate antibiotics treatment and multiple echo-guided treatment.

For POCUS, we can start free fluid survey at pleural base and Morrison’s pouch first , then survey signs of obstruction at  Gallbladder, biliary tree and kidney.
For experienced hands, solid organs, hollow organs and retroperitoneal areas should be included in a comprehensive sepsis survey.

  1. Take home message 
    
    1. History and physical examination should be first 
    
    2. First, find free fluid 
    
    3. Then, survey for signs of obstruction 

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