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Background <p>Klebsiella pneumoniae liver abscess (KLA) is an emerging public health concern in Asia. Involvement of the caudate lobe with concurrent inferior vena cava thrombosis is exceedingly rare but life-threatening. Timely diagnosis and management are critical but challenging. Multimodal ultrasound can play a pivotal role in both diagnosis and treatment guidance.</p> Case presentation <p>A 66-year-old woman with diabetes presented with 10 days of fever and chills. Imaging revealed a caudate lobe liver abscess containing gas with extension to the inferior vena cava (IVC) and associated septic thrombosis. Contrast-enhanced ultrasound and CT confirmed a Klebsiella pneumoniae liver abscess. Ultrasound-guided percutaneous drainage was performed, and cultures identified an ESBL-producing Klebsiella pneumoniae. The patient was treated with broad-spectrum antibiotics, therapeutic anticoagulation, and catheter drainage. Despite an episode of septic shock during hospitalization, she gradually improved, and follow-up imaging showed near-complete resolution of the abscess and complete disappearance of the IVC thrombus.</p> Conclusion <p>The caudate lobe KLA complicated by IVC thrombosis, particularly gas-containing septic thrombosis, is rare but life-threatening. Multimodal ultrasound plays an important role in the early diagnosis and interventional management of KLA complicated by IVC thrombosis. Timely ultrasound-guided drainage with targeted antimicrobial therapy and individualized anticoagulation can achieve effective source control and favorable outcomes without open surgery.</p>

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Multimodal ultrasound in the diagnosis and treatment of caudate lobe Klebsiella pneumoniae liver abscess complicated by rare gas-containing inferior vena cava thrombosis: a case report

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月26日

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  • Wenting Yang,
  • Yimei Deng,
  • Yu Wang,
  • Yang Li

摘要

Background

Klebsiella pneumoniae liver abscess (KLA) is an emerging public health concern in Asia. Involvement of the caudate lobe with concurrent inferior vena cava thrombosis is exceedingly rare but life-threatening. Timely diagnosis and management are critical but challenging. Multimodal ultrasound can play a pivotal role in both diagnosis and treatment guidance.

Case presentation

A 66-year-old woman with diabetes presented with 10 days of fever and chills. Imaging revealed a caudate lobe liver abscess containing gas with extension to the inferior vena cava (IVC) and associated septic thrombosis. Contrast-enhanced ultrasound and CT confirmed a Klebsiella pneumoniae liver abscess. Ultrasound-guided percutaneous drainage was performed, and cultures identified an ESBL-producing Klebsiella pneumoniae. The patient was treated with broad-spectrum antibiotics, therapeutic anticoagulation, and catheter drainage. Despite an episode of septic shock during hospitalization, she gradually improved, and follow-up imaging showed near-complete resolution of the abscess and complete disappearance of the IVC thrombus.

Conclusion

The caudate lobe KLA complicated by IVC thrombosis, particularly gas-containing septic thrombosis, is rare but life-threatening. Multimodal ultrasound plays an important role in the early diagnosis and interventional management of KLA complicated by IVC thrombosis. Timely ultrasound-guided drainage with targeted antimicrobial therapy and individualized anticoagulation can achieve effective source control and favorable outcomes without open surgery.