Case: You have been called in ER to evaluate 21 year old male with hypotension, dehydration, severe diarrhea and abdominal tenderness which is more pronounced in right upper quadrant. On exam you noticed hepatomegaly. History is remarkable with visit to rural parts of South Africa recently. You send septic workup along with stool examination and asked for STAT abdominal ultrasound at bedside with focus on right upper qudrant. Ultrasound technician at bedside showed you a solitary abcess located in the right hepatic lobe. Based on travel history and ultrasound finding, what is the probable diagnosis ?
A: AMOEBIC LIVER ABSCESS
In comparison to pyogenic liver abcesses, amoebic abcess tend to be a solitary abscess. The preponderance of amoebic liver abscess in the right lobe may be explained by streaming of blood in the portal vein. Amebiasis most frequently affects the right side of the colon. Flow from the superior mesenteric vein, which drains the right side of the colon, goes to the right hepatic lobe, whereas flow from the inferior mesenteric and splenic veins goes to the left lobe.
Read nice review Amoebic Liver Abscess (pdf) - MP Sharma, Vineet Ahuja - Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi. Journal, Indian Academy of Clinical Medicine Vol. 4, No. 2, April-June 2003, 107-11
