# Undiagnosed Perihepatic Abscess Revealed at Autopsy of a Patient With COVID-19 Undergoing Prolonged Extracorporeal Membrane Oxygenation (ECMO) Therapy

## TL;DR

A patient with long-term COVID-19 on ECMO therapy developed an undiagnosed liver abscess, found only at autopsy, highlighting the need for better diagnostic approaches in such cases.

## Contribution

Highlights the under-recognized risk of perihepatic abscess in prolonged ECMO patients with COVID-19 and suggests improved imaging strategies.

## Key findings

- A perihepatic abscess was identified at autopsy in a patient with prolonged ECMO due to COVID-19.
- Pre-mortem imaging failed to detect the abscess, suggesting limitations in current diagnostic methods.
- The case underscores the importance of using combined ultrasonography and CT for diagnosing infections in ECMO patients.

## Abstract

The use of extracorporeal membrane oxygenation (ECMO) increased during the COVID-19 pandemic. However, complications associated with the long-term use of ECMO are poorly understood.

This case report describes the autopsy findings of a perihepatic abscess in a patient with long-term COVID-19, which could not be diagnosed before death. In cases where the source of infection remains elusive but uncontrolled infections occur, we recommend the combined use of ultrasonography and contrast-enhanced computed tomography (CT) in patients with COVID-19 undergoing prolonged ECMO support, with particular consideration given to the potential development of cholecystitis.