|Case 5 :|
A 55-year-old male presents with acute pain in the right hypochondrium and high-grade fever of 2 days duration. He gets immediate relief an hour after admission. An ultrasound of the abdomen, and subsequently a CT scan is performed. What is the diagnosis?
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Ultrasound shows an irregular, echogenic mass lesion in the right lobe of liver. It shows irregular shadowing from its peripheral aspect. A small right sided pleural effusion is seen along with free fluid in the abdomen.
CT scan of the abdomen is performed and it shows a large abscess in the right lobe of liver with air pockets within. Right sided pleural effusion with a small consolidation in the right lower lobe of lung is seen. Free fluid is noted in the abdomen.
Amoebic liver abscess which has ruptured into lung.
Amoebic liver abscess (ALA) is the most frequent complication of amoebiasis and occurs in 3-9 % of cases or 42% of patients hospitalized for amoebiasis. Delay in establishing the diagnosis of ALA of inadequate therapy may result in serious complications or even death. Death could occur due to intra thoracic perforation into the pleura, bronchi, pericardium, or intra abdominal rupture into the peritoneal cavity, bile ducts or bowel.
Catheter drainage is a well-established mode of treatment for ALA especially when performed for standard indications. Percutaneous catheter drainage has also been found useful in drainage of collections in ruptures amoebic abscesses.
Von Sonnenberg E. et al. Intra hepatic amoebic abscesses: indications for and results of percutaneous catheter drainage. Radiology 1985; 156: 631-5.
Adams EB, MacLeod. Invasive amoebiasis II. Amoebic liver abscesses and its complications. Medicine 1977; 56: 325-34.
Dr. Sanjeev Mani, Mumbai.