Pyogenic Abscess in a Patient With Alcoholic Cirrhosis

The risk for the development of hepatocellular carcinoma (HCC) increases with the presence of end-stage liver disease such as alcoholic cirrhosis. Therefore, when scanning patients with cirrhosis, it is important to thoroughly investigate the liver for lesions. In this case, a sonogram on a patient with alcoholic cirrhosis resulted in the finding of an abnormal liver mass. Given the patient's history, HCC topped the list of differential diagnoses. Subsequent computed tomography images appeared to show some connectivity between the biliary tree and the mass; therefore, a biloma was included in the differential diagnosis. Biopsy identified the mass as an abscess. Drainage of the abscess was planned after endoscopic retrograde cholangeopancreatography to decompress the biliary system. Clearly, liver masses may be difficult to diagnose and often require a multitude of medical modalities before a definitive diagnosis can be made.