Liver abscess presenting with dyspnea and right-side neck pain that can be overlooked in the emergency department: a case report

Liver abscess is a potentially fatal mass associated with liver injury and disease with a mortality rate of 12% if treatment is delayed. Patients usually complain of fever or upper abdominal pain; however, atypical symptoms, such as right shoulder pain, may also appear. We report a case of liver abscess presenting as dyspnea and right-side neck pain without any other symptoms. A 78-year-old man visited the hospital complaining of right-side neck pain, which had persisted for 10 days, and dyspnea that developed over time. The neck pain and dyspnea were aggravated with changes in posture. Arterial blood gas results (pH 7.47, PO2 76 mmHg, PCO2 33 mmHg, SpO2 98%) and chest and neck X-rays were normal, but white blood cell and C-reactive protein levels were higher than normal. A contrast-enhanced computed tomography scan of the chest was performed to differentiate the unexplained dyspnea and neck pain, and the liver abscess, which was diagnosed accidentally. Clinicians should consider liver abscess as a differential diagnosis in patients with dyspnea or neck pain when there is an increase in inflammatory marker, but it is difficult to explain the cause.