Multiple Air-Fluid Levels Under Right Dome of the Diaphragm

A 50-year-old male patient presenting with recurrent pain abdomen and fever was diagnosed to have multiple liver abscesses. An erect X-ray abdomen showed multiple air-fluid levels in the region of the liver raising the possibility of abscess by gas-forming pyogenic abscess which was later confirmed by CECT scan. He was managed conservatively with antibiotic therapy followed by complete resolution. The X-ray, which usually shows single air-fluid level for a gas-forming pyogenic liver abscess (GPLA), was quite remarkable and unusual in this case.