Gas-filled abscesses and gas gangrenes are extremely rare causes of intrahepatic gas. Even rarer, however, is the occurrence of gas within the non-portal hepatic veins. Most often seen in diabetic patients, dissemination and hepatic seeding of bacteria has been linked to procedures such as femoral catheters as well as liver lacerations and pyelonephritis. We report the case of a 69-year-old relatively healthy male who presented to our emergency department with abdominal pain and a fever of 103.3°F (39.6°C). A contrast-enhanced computed tomography scan of the abdomen revealed multiple hepatic abscesses and gas within the hepatic venous system as well as pneumocardia. In conclusion, gas within the non-portal hepatic veins is usually an indication of a serious underlying condition and its immediate identification is essential for treatment as hematogenous dissemination has already begun.

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