Dr. S.A Satti: Amoebic liver abscess, Pre and post aspiration ultrasonic pictures

In this article we will discuss the ultrasonic picture of amoebic liver abscess and its percutaneous aspiration.

A 40 year old male patient presented to medical OPD, complaining of severe right hypochondrial pain, high grade fever, vomiting, generalized weakness and anorexia. He had been suffering from these symptoms since last 10 days. He went to several doctor and took oral medication (Oral ciprofloxacin 500mg x BD and Tab Metronidazole 400mg x TDS for 5 days), but his symptoms didn’t improve. He came to Capital Hospital Islamabad where his blood investigations were done which showed leukocytosis and high level of liver enzymes. Latter on his ultrasound was planned which was done by Dr. Siddique Akbar Satti, consultant physician and head of medical department himself. On the ultrasound a single large liver abscess was seen. Below is the ultrasonic view of his liver.

In the above ultrasonic view you can see a large ovoid cavity. This is liver abscess.

“Unlike pyogenic liver abscesses which are small and multiple, Amoebic liver abscess is usually large and solitary” said Dr. Siddique Akbar Satti.

The size of this abscess corresponded to the volume of 841.35 ml. This was a huge liver abscess.

“This liver abscess is huge. This explains why the patient isn’t responding to oral medication. Such a huge liver abscess must be percutaneously drained. Draining of amoebic liver abscess combined with oral medication hastens the patient recovery” Dr. Satti told his students while examining the patient with ultrasound probe.

After the diagnosis, the liver abscess was drained on the same day. It was drained with the help of ultrasound guided percutaneous needle aspiration. Below is the post- aspiration ultrasonic picture of liver abscess of the same patient.

Please note that the volume had decreased significantly. It was decreased from the value of 841 ml to 164 ml. This was 80 % decrease in volume. The oral medication were continued. On the next day of aspiration, patient condition had improved. His blood level of liver enzymes started to fall and he was discharged from the hospital after 7 days.

 

Special Thanks

Dr. Siddique Akbar Satti, Head Department of Medicine, Capital Hospital Islamabad, Pakistan