When liver meets lung: A rare hepaticobronchial fistula with endobronchial spread

Abstract

Hepatic abscesses are uncommon but potentially life-threatening conditions. Rarely, they may extend across the diaphragm to form hepatobronchial fistulae with associated pulmonary complications. We report a case of a 34-year-old male with a gas-forming hepatic abscess complicated by a hepatobronchial fistula and endobronchial seeding. Multimodality imaging including ultrasound and CT demonstrated the hepatic abscess, transdiaphragmatic communication, and tree-in-bud nodules in the lung. The patient underwent percutaneous drainage with pigtail catheter placement, and pus culture grew Escherichia coli. He improved clinically with antibiotics and drainage. This case underscores the importance of recognizing rare hepatic abscess complications with imaging to guide prompt management.