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 
  2. 
    
  3. 1. History and physical examination should be first 
  4. 
    
  5. 2. First, find free fluid 
  6. 
    
  7. 3. Then, survey for signs of obstruction 

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