A computed tomography (CT) scan of the chest (Figure 2) showed multiple thick-walled cavitary lesions in the right lower lobe with associated pleural thickening. A CT scan of the abdomen (Figure 3) showed a complex, septated fluid collection involving the liver with dense inhomogeneous contrast enhancement in the walls and extending into the posterior pararenal space. ventolin inhaler
CT-guided transthoracic needle aspiration revealed purulent material. A Gram stain of the fluid showed many white blood cells and Gram-positive, filamentous, branching organisms. Aerobic, anaerobic, fungal and tuberculous cultures were negative, as were modified acid-fast smears. The diagnosis was hepatic actinomycosis with involvement of the diaphragm and ipsilateral lung. The patient received penicillin therapy and demonstrated complete clinical and radiographical resolution.
Figure 2) Computed tomography of the chest showing multiple thick-walled cavitary lesions in the right lower lobe with associated pleural thickening
Figure 3) Computed tomography of the abdomen showing a complex, septated fluid collection with a thick, irregular, contrast enhancement in the wall involving the liver and extending into the posterior pararenal space