Background: The aim of the study was to evaluate the clinical presentation and to compare the effectiveness of pigtail catheter drainage and percutaneous needle aspiration in the management of liver abscess. Methods: This is a prospective randomized comparative study of 100 patients, presented in outpatient and emergency department at the hospital, randomized equally into two groups, percutaneous needle aspiration and pigtail catheter drainage. The effectiveness of either treatment was measured in terms of duration of hospital stay, days to achieve clinical improvement, 50% reduction in abscess cavity size and total/near total resolution of abscess cavity. Results; The success rate was significantly better in catheter drainage group. The patients in pigtail catheter drainage group showed earlier clinical improvement and 50% decrease in abscess cavity volume as compared to those who underwent percutaneous needle aspiration. Conclusion: Percutaneous catheter drainage is a better modality as compared to percutaneous needle aspiration especially in larger abscesses which are partially liquefied or with thick pus