Diagnosis of Empyema as a Complication of Liver Abscess in Peripheral Area

Abstract

Right pleural empyema is one of the rare complications in liver abscess. This condition is life-threatening as it causes breathing difficulties and requires immediate life-saving. This case report aims to diagnose and manage empyema in a male patient with a liver abscess in a limited diagnostic setting. Methods: According to medical records, a 44-year-old man came to the emergency room (ER) of Umbu Rara Meha General Hospital with complaints of shortness of breath that had been getting worse for two months, accompanied by a cough with phlegm for one week, fever, and weight loss. The patient also complained of pain in the right upper abdomen for the last four months. History of pulmonary tuberculosis, diabetes mellitus, or hypertension was denied. The patient is not a smoker. On physical examination, there was an increase in the frequency of breathing and a decrease in the vesicular sounds on the right side. Right thorax X-ray examination revealed massive right pleural effusion without pulmonary infiltrates. Abdominal ultrasound showed a liver abscess. Emergency pleural puncture was performed in the ER, and 1600 cc of purulent pleural fluid was removed, followed by Water Sealed Draignase (WSD) installation. The patient was given intravenous broad-spectrum antibiotics and treated for 12 days.

Conclusion: Empyema can be a rare but life-threatening complication of liver abscess. Medical action must be taken immediately in the ER to save the patient. Delaying pus drainage can increase morbidity and mortality rates.