Tom is a 1-year-old child who was brought to our observation 3 weeks ago.
He had been visited in another facility because of important, palpable hepatomegaly. In that hospital an ultrasound was performed and a round hypoechogenic mass of about 10 cm diameter was seen in the left lobe of the liver.
Nevertheless the doctor was not able to understand the nature of the liver mass and referred the patient for an abdominal CT scan, which was non-affordable for the mother.
Therefore she came to Chaaria for second opinion and for any help we could give.
I decided to repeat the ultrasound (U/S) myself and I have actually confirmed the presence of the liver mass.
Taking just few minutes longer while staring at the monitor, I have noticed the continuous slight movements which are typical of a semi-liquid mass.
Taking just few minutes longer while staring at the monitor, I have noticed the continuous slight movements which are typical of a semi-liquid mass.
Immediately the diagnosis came to my mind: it was not a solid mass, but an abscess!
I called my assistant and the anesthetist with the plan of doing a U/S guided needle aspiration of what I strongly believed to be an amoebic liver abscess… and in fact: bingo: we recovered thick, foul smelling, and brown pus, quite suggestive of the condition.
In total we have drained 150 ml: at the end of the procedure the mass had completely disappeared.
We have also sent samples to the laboratory, making sure that it was pus collected very near to the edge of the abscess (where we expect the trophozoites and the cysts to be found more easily): bingo again: the sample was positive for entamoeba hystolitica.
We had discharged the child on a 2 weeks course of metronidazole.
Today the mother has come for review. Tom was perfectly healthy and the U/S control was again negative: there was no relapse of the liver abscess.
It was a great success which we have achieved even without an expensive CT scan.
Br Dr Giuseppe Gaido
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