Pyogenic Liver Abscess and the Important Role of Point-of-Care Ultrasound (POCUS) in Daily Practice: A Report of Two Cases

A pyogenic liver abscess (PLA) is uncommon and a potentially life-threatening condition. Clinical manifestations and laboratory investigations can be non-specific and the detection of PLAs requires imaging, which can often be delayed. Point-of-care ultrasound (POCUS) is now becoming more widely adopted and plays an important role in clinical practice. We report two cases of PLA, one of which was a gas-forming PLA that we encountered in a district general hospital where POCUS played an important role in the diagnosis and management. The diagnoses of PLAs were initially unsuspected due to a combination of non-specific symptom manifestations, initial negative imaging, and a subtle radiological clue that was missed due to a lack of awareness. Bedside POCUS examinations were done due to clinical deterioration in one patient and lack of inflammatory marker improvement in both patients. These cases highlight the important role of POCUS in the management of patients with liver abscesses.