Woman with fever and epigastric pain

A 54-year-old female without a medical history presented to the emergency department (ED) with fever and epigastric pain for 2 days. Laboratory findings showed a white blood cell count of 18,400/µL and a C-reactive protein level of 20.47 mg/dL (normal <0.5 mg/dL). Point-of-care ultrasound (POCUS) demonstrated a hypoechoic focus in the left hepatic lobe adjacent to the gastric antrum. Furthermore, a hyperechoic and linear structure, measuring 3.57 cm in length was identified, connecting those two structures (Figure 1; Video 1).

Abdominal computed tomography (CT) was performed and confirmed the diagnosis (Figure 2). Exploratory laparotomy revealed perforation of the stomach (pre-pyloric) with the fishbone penetrating the liver, which was then removed surgically (Figure 3). The patient recovered well without any complications.

Although rare, liver abscesses caused by ingested fishbones can occur. CT scans are the current diagnostic standard for such cases.¹ To the best of our knowledge, this is the first reported case in the English literature where POCUS has been utilized to diagnose a liver abscess caused by a fish bone. Using POCUS to determine if a liver abscess is caused by a foreign body is crucial, since its treatment often requires surgery,² as demonstrated in this case.