Investigations:
Admission labs were pertinent for a hemoglobin of 5.6 g/dL, a WBC of
12.4 K/microL, and a lactic acid of 2.5 mmol/L. Negative labs included
HIV, hepatitis panel, Neisseria gonorrhoeae , RPR, EBV IgM, IgG
and antigen, Plasmodium falciparum antigen and thin and thick
blood smear. Chest CT demonstrated a hepatic abscess to pericardial
communication (Figure 1). Triple phase abdominal CT scan showed multiple
liver abscesses with communication into the right cardiophrenic space
(Figure 2). Hepatic abscess aspirate cultures grew Fusobacterium
nucleatum . A transthoracic echocardiogram (TTE) revealed a large
pericardial effusion, and serial TTEs demonstrated expansion of this
effusion leading to tamponade physiology with diastolic right
ventricular collapse and tricuspid valve E inflow respiratory variation
>60% (Figures 3, 4). Pericardiocentesis was performed
with 300 mL of fluid removed out of which no organisms were isolated.
Repeat CT abdomen and pelvis showed persistent multiloculated fluid
collections (Figure 5). MRI pelvis confirmed a right adnexal
multiloculated mass concerning for tubo-ovarian abscess (Figure 6),
ultimately requiring percutaneous nephrostomy due to mass effect and
subsequent hydronephrosis.