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An Unusual Presentation of Amebic Liver Abscess

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Topic: Amebic liver abscess
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Sort Desciption: An Unusual Presentation of Amebic Liver Abscess A 48 years old, non-alcoholic male presented with gradual swelling of right upper abdomen two months. ...

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An Unusual Presentation of Amebic Liver Abscess A 48 years old, non-alcoholic male presented with gradual swelling of right upper abdomen two months. His complaints started with dull aching pain localized in right upper quadrant of abdomen. After a few days he noticed a swelling in right upper abdomen which gradually increased. There was no history of fever, vomiting, haematemesis or malena. On examination, there was a visible swelling over the right hypochondrium with engorged and tortuous abdominal and back veins (Fig. 1A &B) filling from below upwards. The patient had tender hepatomegaly (span 16 cm in right clavicular line) without palpable splenomegaly or ascites. Other systems examination revealed no abnormality. Investigation revealed a normal hemogram(11.5gm/dl) and serum bilirubin (0.8mg/dl), total serum protein 6.7gm/dl, serum albumin 3.5gm/dl, aspartate aminotransferase(AST) 36 IU/L, alanine aminotransferase(ALT) 42 IU/L, alkaline phosphatase 950IU/L. Prothrombin time was 14.8 seconds (control 13.0seconds).Viral markers for hepatitis B and C were negative. Doppler ultrasound examination revealed an abscess cavity (12.5 x 13.2 cm) in the right lobe of liver compressing the inferior vena cava (Fig. 2A & B) and right and left hepatic veins (Fig. 3A & B) with loss of phasic variation of Doppler waves. Spleen was 12cm in its axis. Portal vein diameter was 14mm at porta.Ultrasound guided aspiration of the abscess cavity revealed anchovy-saucepus. Upper G.I. endoscopy showed no varices. So a diagnosis of amebic liver abscess with Budd-Chiari Syndrome was made. Ultrasonography guided tube drainage was given along with medical treatment. Within 24 hours of decompression of liver abscess abdominal and back veins collapsed. Budd-Chiari Syndrome results from the occlusion of hepatic veins or inferior venacava.The important causes are thrombosis of ...

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