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10 April 2019 : Case report  Italy

Successful Diagnosis of a Longstanding Giant Amoebic Liver Abscess Using Contrast-Enhanced Ultrasonography (CEUS): A Case Report in a Western Country

Challenging differential diagnosis, Management of emergency care, Rare disease

Giuseppe Marenga1ABCDEFG*, Silvia Traficante1ABCDEF, Serena Ragonici1AEF, Claudia Vincenzi1AEF, Maura Rocchetti1AEF, Giuseppe De Rito1AEF, Giovanni Battista Fonsi1ABCE, Daniela Messineo2BCDG

DOI: 10.12659/AJCR.914378

Am J Case Rep 2019; 20:493-498

Abstract

BACKGROUND: E. histolytica liver abscess results from extra-intestinal diffusion of amebiasis, which is responsible for up 100 000 deaths per annum, placing it second only to malaria in mortality. Currently, the criterion standard for the diagnosis of liver abscesses is ultrasound, but CEUS (contrast-enhanced ultrasound) is emerging as a more accurate method for liver study, and it could be more accurate than ultrasound and non-invasive compared to CT.

CASE REPORT: A white man (59 years old) with a 2-day history of dyspnea, acute abdominal pain in right upper quadrant, and raised inflammatory markers was admitted to a second-level Emergency Department in Rome (Italy). He reported several trips to tropical areas many years before, during which he ingested non-potable water and became infected with Entamoeba histolytica. This was treated medically with success. After administration of antibiotics (meropenem and metronidazole), a liver CEUS (contrast-enhanced ultrasonography) with administration of SonoVue (sulphur hexafluoride microbubbles) confirmed a giant liver abscess (15×16 cm). One day later, CT-guided drainage was performed without complications and the patient was discharged on the 25th post-procedure day, with improved blood results.

CONCLUSIONS: Acute abdominal pain can be caused by a variety of diseases, but a diagnosis of parasitic abscess should not be overlooked in non-endemic Western countries. CEUS is a new, promising, and more accurate technique that can be utilized to recognize liver abnormalities, including abscesses; however, retrospective population-wide studies are necessary to define the differential diagnoses.

Keywords: Abdomen, Acute, Entamoeba histolytica, Liver Abscess, Amebic, Liver Diseases, Tomography, X-Ray Computed, Ultrasonography, Contrast Media, Phospholipids, Sulfur Hexafluoride, Travel-Related Illness

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923