Presentation
Fever and left hypochondrial abdominal pain.
Patient Data
A hypodense mass in the left hepatic parenchyma, measuring approximately 82 × 57 × 46 mm, with internal septations, peripheral and septal contrast enhancement, and clear visualisation of the cluster sign and double target sign in the venous phase. Inflammatory thickening of the left diaphragm and sub diaphragmatic fat and peritoneum. Left basal atelectasis, small pleural effusion and large paracardiac lymph nodes.
Partial eventration of the right diaphragm.
Incidental small cyst in the right hepatic lobe.
Simple renal cysts in both kidneys.
Case Discussion
Blood tests show elevated white blood cell count (12 G/L) and increased eosinophil percentage (20%).
Ultrasound-guided percutaneous abscess drainage was performed, yielding thick brown purulent fluid. E. histolytica PCR of the aspirated material was positive.
Imaging and laboratory findings are consistent with a left amoebic hepatic abscess with incipient extension to the left thoracic cavity via the diaphragm.
After abscess drainage combined with antibiotic treatment for amebiasis, the patient's clinical symptoms and laboratory findings improved significantly. She was discharged shortly thereafter.
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