Pyogenic liver abscess with two normal ultrasound scans

I report a case of a large liver abscess causing a severe debilitating condition in which the diagnosis was delayed by several weeks following two normal ultrasound scans at days 5 and 19 of the illness. Up to one in four cases of liver abscess can be missed on ultrasound. A high degree of clinical suspicion must be maintained and repeated or alternative imaging methods used if the diagnosis of this rare, curable but often fatal condition is not to be missed.