Background: Liver abscess, a disease troubling mankind from ancient times, has earliest documentation in the Sanskrit document. Where right upper abdominal pain, have potentially lethal consequences, if prompt diagnosis and treatment are not accomplished. However, two major types are known, Amoebic and Pyogenic, in medical literature. Pyogenic liver abscess constitutes major bulk of hepatic abscess in western countries. The diagnosis is confirmed by ultrasonography, reddish brown (anchovy–paste like material) aspirate from abscess. The diagnosis, treatment and prognosis, of liver abscess have evolved remarkably over past few years. Imaging has improved diagnostic competence and has altered therapeutic strategy. The study aims at early clinical and diagnosis on imaging of liver abscess, to set up some guide lines in view of conservative or either intervention. Methods: The present study was hospital based longitudinal study, carried out in tertiary care teaching hospital from April 2016 to September 2019. A total of 65 patients were enrolled in the study. All patients with suspicion of having liver abscess were confirmed on Imaging and included as present study population. This study was mainly based on presentation, role of conservative treatment, aspiration, pigtail catheter, outcome and post procedural complications. Results: All patients presented with pain right or left upper abdominal pain, any chest complaints, majority of present study group patients had fever with or without rigors, deranged liver function. Imaging is the most diagnostic method, and also helped in therapy and follow up. Conclusions: Males are affected more than females, Imaging is the best modality for diagnosis, therapy and follow up. Aspiration or pigtail drainage is the standard method of drainage. Pigtail drainage is the better method of treatment than aspiration.