The rim sign in hepatic abscess: case report and review of the literature.

Abstract

We studied a previously healthy patient who presented with a 3-wk history of fever, flu-like symptoms and abdominal pain. Blood cultures were positive for Escherichia coli. A computed tomography (CT) scan revealed a 2-cm low-density focus in the right hepatic lobe. A technetium-99m-mebrofenin scan showed a photopenic area in the right hepatic lobe surrounded by a rim of activity greater than the adjacent parenchymal activity. Gallbladder visualization was normal and the diagnosis of hepatic abscess was made. CT-guided percutaneous drainage of the lesion yielded six cc of pus, the culture of which grew E. coli, Prevotella and Bacteroides fragilis. Drainage and a 6-wk course of intravenous antibiotics were followed by clinical improvement and resolution of the abscess by CT. The rim sign and its possible mechanism of causation in hepatic abscess are discussed in this report, together with a review of the literature.