Hepatic abscess in liver transplantation. Accurate diagnosis and treatment

Serial HIDA scanning was performed on a patient following liver transplantation. During the patient's course he developed biliary obstruction that manifested as a photopenic region in the liver, on the HIDA scan which filled in on the delayed views. The patient subsequently developed a region in the superior portion of the right lobe of the liver that did not fill in with activity on delayed views. The patient was experiencing low-grade fevers and was clinically believed to have either an abscess or an episode of rejection. A gallium scan was performed revealing a photopenic defect in the same region as the HIDA. Because of the clinical suspicion of abscess, a percutaneous transhepatic drainage study was performed, revealing a large abscess cavity in the suspect area within the liver. Following the drainage the patient did well. This case illustrates the usefulness of serial HIDA scanning in patients who have received liver transplants. It also is important to note that the gallium scan was negative in this hepatic abscess. In the authors' opinions, the finding of an intrahepatic fluid collection in a septic patient that does not fill with activity on the HIDA study, should be considered the source of the infection, until proven otherwise, and should be drained regardless of the findings of other studies.