TTP7.06 Fish-bone: Uncommon presentation as liver mass

Aim Reporting a rare case of a liver abscess caused by a fish-bone, masquerading as primary or secondary liver lesion. Background A 63-year-old female with a 3 week history of recurrent abdominal pain, fever, and chills was initially suspected to have a gastrointestinal stromal tumour (GIST) and was referred to our HPB unit for further evaluation. Further radiology review suggested a heterogenous liver mass of uncertain aetiology. Laboratory investigations were largely unremarkable, with notable findings including thrombocytosis (485 x10⁹/L), hypoalbuminemia (32 g/L), and a mildly elevated C-reactive protein level (13 mg/L). Investigations and Diagnosis A CT scan showed an 8.7 (AP) x 6.5 (lateral) x 6.8 cm (craniocaudal) heterogenous mass that appeared to be arising from the left lobe of the liver (involving segments 2 and 3) and eroding through the anterior abdominal wall into the subcutaneous tissues. A 3 cm serpiginous focus of high attenuation was seen in the posterior aspect of the lesion. The patient underwent three weeks of antibiotic therapy with Co-amoxiclav, Ceftriaxone, and Metronidazole with no clinical improvement. Further evaluation led to the drainage of a liver abscess in segment II/III, revealing green frank pus that cultured Streptococcus constellatus. The patient failed medical management, and a surgical approach was established with the excision of a segment III containing foreign body (Fish-bone). Conclusion Fish-bone-related liver abscess can present as lesions in liver and masquerade as other lesions (primary liver masses/mets).