J Med Cases

Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc

Journal website http://www.journalmc.org

Case Report

Volume 6, Number 8, August 2015, pages 346-349

Pyogenic Liver Abscess Mimicking Liver Neoplasm on Computed Tomography Scan in a Patient With Elevated CA 19-9

Figure

Figure 1. Hepatic abscess caused by Streptococcus constellatus mimicking HCC or hepatic metastasis. (A) Abdomen US demonstrating two hypodense heterogenous right hepatic lobe lesions measuring 3 × 3.8 cm and 5.3 × 3.6 cm. (B) Initial contrast enhancing CT scan illustrating multifocal multi-septated enhancing lesions. (C) Contrast enhanced CT showing improvement in hepatic multi-septated abscesses following 4 weeks of antibiotic therapy.

Table

**Table 1.** Laboratory Data on Admission (in SI Units)
Parameter	Value	Reference range
White blood count (× 10⁹/L)	12.6	4.5 - 11.0
Neutrophils (proportion of 1.0)	0.08	0.56
AST (µkat/L),	7.98	0.17 - 0.51
ALT (µkat/L),	6.5	0.17 - 0.68
Total bilirubin (µmol/L)	10.26	5.0 - 21.0
Alkaline phosphatase (µkat/L)	1.35	0.5 - 2.0
Glucose (mmol/L)	26.25	3.9 - 6.1
Acetone (mmol/L)	0.34	< 0.17
Beta hydroxybutyrate (µmol/L)	1,189.22	< 300
Serum osmolality (mmol/kg)	316	275 - 295
Creatinine (µmol/L)	146.74	53 - 106
BUN (mmol/L)	19.99	2.9 - 8.2
Lactate dehydrogenase (µkat/L)	7.26	1.7 - 3.4
Prothrombin time (second)	14.8	Control 10.0 - 13.3 s
Activated partial thromboplastin time (second)	26.4	Control 23 - 33 s
Lactic acid (mmol/L)	6.8	0.6 - 1.7
Anion gap (mmol/L)	19	8 - 16
Hemoglobin A1C (proportion of 1.0)	0.08	0.02 - 0.03
Hepatitis C Ab	Non-reactive	Non-reactive
Hepatitis Ag index	Non-reactive	Non-reactive
CA 19-9 (kU/L)	163	< 35
Alpha-fetoprotein (µg/L)	< 1.3	< 10
Arterial blood gas
PH	7.341	7.35 - 7.45
PCO₂ (kPa)	4.83	4.7 - 5.9
CO₂ (mmol/L)	19	21 - 28