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, 11 (2), 1-7
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Image-guided Percutaneous Transhepatic Removal of Fish Bone From Liver Abscess

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Case Reports

Image-guided Percutaneous Transhepatic Removal of Fish Bone From Liver Abscess

Chin Wah Lau et al. J Radiol Case Rep.

Abstract

We present a case of a woman who was diagnosed with a hepatic abscess secondary to a migrated fish bone. As the patient did not improve after percutaneous drainage of the abscess, image-guided percutaneous transhepatic removal of the fish bone was performed. Fish bones in hepatic abscesses are typically removed surgically, with the fish bone left in situ in a number of cases. There has been only another reported case of percutaneous transhepatic fish bone removal. We conclude that in the rare case of a hepatic abscess complicating fish bone migration, image-guided percutaneous transhepatic removal of the offending foreign body is a feasible alternative to surgery, especially in high surgical risk patients.

Keywords: Fish bone; foreign body migration; hepatic abscess; intervention; percutaneous removal.

Figures

Figure 1
Figure 1
85-year-old female patient with liver abscess from fish bone. Initial CT abdomen and pelvis with intravenous contrast. FINDINGS: Coronal (A), axial (B) and sagittal (C) sections demonstrate a high density linear foreign body (arrow) within a hypodense mass with thick and irregular enhancing rim compatible with abscess in the left lobe of the liver. The abscess measures 4.1 × 4.0 × 4.6 cm. Note that the distal stomach closely abuts this mass. TECHNIQUE: 3mm axial with coronal and sagittal reconstruction computed tomography images obtained on a Siemens® SOMATOM® 64 slice spiral CT scanner at 256mAS, 1.2 KV and 500 msec.
Figure 2
Figure 2
85-year-old female patient with liver abscess from fish bone. Initial coronal CT abdomen and pelvis with intravenous contrast. FINDINGS: White circle illustrates the thickened and edematous pylorus of the stomach which was seen to closely abutting the hepatic abscess. TECHNIQUE: 3mm coronal reformatted computed tomography images obtained on a Siemens® SOMATOM® 64 slice spiral CT scanner at 256mAS, 1.2 KV and 500 msec.
Figure 3
Figure 3
85-year-old female patient with liver abscess from fish bone. Non-contrast CT abdomen and pelvis. FINDINGS: Axial section demonstrates the drainage catheter (thick arrow) and a high density foreign body (thin arrow). TECHNIQUE: 3mm axial computed tomography images obtained on a Siemens® SOMATOM® 64 slice spiral CT scanner at 256mAS, 1.2 KV and 500 msec.
Figure 4
Figure 4
Percutaneous retrieval of fish bone in an 85-year-old female patient with liver abscess in the left lobe. FINDINGS: Fluoroscopic image showing removal of the foreign body (short arrow) which was initially attempted with a 9–15mm Ensnare device (long arrow), but this was unsuccessful. TECHNIQUE: Diagnostic/therapeutic fluoroscopy in the PA projection (patient supine), 80 kV, 3mAs.
Figure 5
Figure 5
Percutaneous retrieval of fish bone in an 85-year-old female patient with liver abscess in the left lobe. FINDINGS: Fluoroscopic image showing the Argon endomyocardial biopsy forceps (long arrow) grasping the fish bone (short arrow). TECHNIQUE: Diagnostic/therapeutic fluoroscopy in the PA projection (patient supine), 80 kV, 3mAs.
Figure 6
Figure 6
Percutaneous retrieval of fish bone in an 85-year-old female patient with liver abscess in the left lobe. FINDINGS: Fluoroscopic image showing a new 8F Skater catheter was then placed back into the abscess cavity over the safety wire. A small amount of contrast was injected and excluded free extravasation. TECHNIQUE: Diagnostic/therapeutic fluoroscopy in the PA projection (patient supine), 80 kV, 3mAs.
Figure 7
Figure 7
85-year-old female patient with liver abscess from fish bone. Non-contrast CT abdomen and pelvis. FINDINGS: Axial section at the same level as Figure 3 demonstrates the new drainage catheter (arrow) and the previously seen high density foreign body has been removed. Small amount of injected contrast is noted in the vicinity. TECHNIQUE: 3mm axial computed tomography images obtained on a Siemens® SOMATOM® 64 slice spiral CT scanner at 256mAS, 1.2 KV and 500 msec.
Figure 8
Figure 8
85-year-old female patient with liver abscess from fish bone. Clinical images showing the retrieved fish bone.

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