Integrated Diagnostic and Interventional Point‐of‐Care Ultrasound in the Early Management of Multiple Pyogenic Liver Abscesses: Case Report and Narrative Literature Review

ABSTRACT

Pyogenic liver abscesses are uncommon but potentially life‐threatening intra‐abdominal infections requiring prompt diagnosis and source control. Increasing use of point‐of‐care ultrasound (POCUS) enables early bedside detection and immediate therapeutic decision‐making in critically ill patients. We report the case of a 75‐year‐old female with type 2 diabetes mellitus who presented with fever, abdominal pain and sepsis. Bedside POCUS performed within 24 h demonstrated multiple heterogeneous complex hepatic collections involving predominantly segments IVa, IVb, V, VI, VII and VIII, with internal echogenic debris, posterior acoustic enhancement and absent internal vascularity, highly suggestive of pyogenic liver abscesses. Contrast‐enhanced computed tomography could not be performed because the patient was clinically unstable and unable to tolerate transfer outside the intensive care setting. Early ultrasound‐guided percutaneous drainage performed by the hospital percutaneous surgery team with placement of three drainage catheters enabled rapid source control and evacuation of abundant purulent material. Microbiological cultures confirmed Klebsiella pneumoniae infection, and targeted antimicrobial therapy with meropenem was initiated. Serial follow‐up ultrasound examinations demonstrated reduction in collection size, and the patient showed progressive clinical improvement without procedure‐related complications, allowing intensive care unit discharge after 7 days. This report highlights the role of integrated diagnostic and interventional ultrasound in accelerating bedside source control in critically ill patients with intra‐abdominal sepsis, while also discussing the complementary role of conventional cross‐sectional imaging and contrast‐enhanced ultrasound within the broader diagnostic pathway.