Abs Hepatico Amebiano

Amoebic liver abscess (ALA) and its complications:
Revisited
Poster No.: C-1139

Congress: ECR 2011
Type: Educational Exhibit
Authors: 1 2 3
P. S. Naphade , A. A. Raut , A. keraliya , P. nagure , B.
3
4 1 2 3 4
PAI ; Mumbai/IN, Mumbai, MH/IN, mumbai/IN, MUMBAI,
MAHARASHTRA/IN
Keywords: Liver, CT, Conventional radiography, Abscess
DOI: 10.1594/ecr2011/C-1139
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Page 1 of 26
Learning objectives
To study the imaging features and role of imaging in the management of Amoebic liver
abscess (ALA) and its complications.
In this exhibit, we will illustrate the role of ultrasound and CT in the diagnosis of ALA,
determining its extent, its complications and role in image guided aspiration and/or
catheter drainage of ALA.
Background
Intestinal amoebiasis is caused by a protozoan Entamoeba Histolytica.
Infections with the Entamoeba Histolytica are worldwide in distribution but more common
in tropical and subtropical countries. Though the disease evolves in caecum, most
common extra intestinal complication is ALA.
The protozoan reaches the liver parenchyma through the portal vein.
It occurs predominantly in young males. The most common presenting features of

amoebic liver abscess are fever, pain in right upper quadrant and tender hepatomegaly
over a period of 1 to 2 weeks. Jaundice may be present depending upon the extent of
hepatic involvement, compression of biliary system or biliovascular fistula caused by the
damage to hepatic veins and bile ducts by the abscess. Alcoholics, diabetics and HIV
positive patients are more prone to complications of amoebic liver abscess.
Early diagnosis of ALA is imperative; as it is curable while the delay in the diagnosis may
lead to complications with high morbidity and mortality.
In this retrospective analysis, we will illustrate the imaging features and role of imaging
in management of ALA and its complications.
Imaging findings OR Procedure details
Page 2 of 26
An oval or round hypoehoic lesion with thick, irregular walls is the commonest finding
on ultrasound of abdomen. USG is first line investigation in suspected cases of amoebic
liver abscess.
Fig.: Fig.: Ultrasound of liver reveals a well defined, rounded, hypoechoic abscess in
segment VI of the liver with thick walls.
Page 3 of 26
References: P. S. Naphade; Radiology, Seth G.S.M.C. and KEM Hospital, Mumbai,
INDIA
On CT scan, the abscess appear hypodense to normal hepatic parenchyma with

intermediate density of the wall. However in many cases, the wall of the abscess is not
apparent on plain CT scan. The wall of ALA enhances after the contrast administration.
The abscess is surrounded by hyperemic liver parenchyma.
Fig.: Fig.: Contrast enhanced axial CT scan of liver reveals hypodense abscess with
thick shaggy walls with surrounding edema and mild hyperemia
Page 4 of 26
INDIA
Fig.: Fig.: Contrast enhanced axial CT scan in late arterial phase reveals hyperemia
surrounding the liver abscesses.
INDIA
Page 5 of 26
Fig.: Fig.: Contrast enhanced axial CT scan of liver reveals a septum within the
abscess which represents preserved intervening liver parenchyma.
INDIA
Perihepatic localized fluid collection and/or pleural effusion is usually associated with
large abscesses and allows its easy differentiation from other focal liver lesions.
Page 6 of 26
Fig.: Fig.: Contrast enhanced axial CT scan reveals abscess in segment VIII of the
cirrhotic liver with right subdiaphragmatic collection and minimal pleural reaction.
INDIA
Most of the ALA occur in right lobe of liver and are solitary. Multiple abscesses occur in
15-20% cases.
Page 7 of 26
Fig.: Fig.: Ultrasound of liver shows multiple liver abscess scattered in both the lobes.
INDIA
Page 8 of 26
Fig.: Fig.: Coronal reconstruction of a contrast enhanced CT scan reveals multiple
liver abscesses with free intraperitoneal fluid collection.
INDIA
Pleural effusion and localised perihepatic collection are the common complications of
ALA. The reactive pleural effusion and those secondary to rupture of amoebic liver
abscess through diaphragm into pleural cavity cannot be easily differentiated. However
ultrasound can show the real time communication of abscess and pleural cavity through
the rent in the diaphragm.
Common complications are listed below.
Pleural effusion
Sub diaphragmatic collection
Page 9 of 26
Peritoneal rupture
Rupture in pleural cavity
Hepatobronchial fistula
Biliary involvement
Rupture in pericardial cavity
Hepatic vein thrombosis
Portal vein thrombosis
Inferior vena cava(IVC) thrombosis
Page 10 of 26
Fig.: Fig.2a: Contrast enhanced axial CT scan of liver shows multiple amoebic liver
abscesses in right lobe of liver.
INDIA
Fig.: Fig.2b: Contrast enhanced axial CT scan reveals rupture of the abscess with
resultant right subdiaphragmatic collection and reactive mild right pleural effusion.
INDIA
Page 11 of 26
Fig.: Fig.: Contrast enhanced axial CT scan of liver reveals ruptured ALA in segment
VII of the liver with involvement of muscles of right posterior parietal abdominal wall.
INDIA
Page 12 of 26
Page 13 of 26
Fig.: Fig.: Sagittal reconstruction of contrast enhanced CT scan reveals ALA
in segment VII of the liver with involvement of muscles of right posterior parietal
abdominal wall and perihepatic fluid collection.
INDIA
Page 14 of 26
Fig.: Fig.: Coronal reconstruction of contrast enhanced CT scan reveals the rupture of
ALA in segment VIII into the right pleural cavity with extensive right pleural collection.
INDIA
Fig.: Fig.: Ultrasound of abdomen excellently demonstrates the rent in diaphragm

through which the ALA communicates with right pleural cavity.The right lung is
collapsed.
INDIA
Page 15 of 26
Fig.: Fig.: Nonionic contrast instilled in the ALA through the pigtail catheter reveals
communication of hepatic abscess and right lower lobe bronchus suggestive of
hepatobronchial fistula.
INDIA
Page 16 of 26
Fig.: Fig.: Contrast enhanced axial CT scan reveals intrathoracic rupture of ALA with
pericardial extension.
INDIA
Page 17 of 26
Fig.: Fig.: Non ionic contrast instilled in the ALA through drainage catheter reveals
biliary communication of ALA.
INDIA
Page 18 of 26
Fig.: Fig.: Contrast enhanced axial CT scan of liver reveals the right hepatic vein
traversing through the ALA is thrombosed.
INDIA
Page 19 of 26
Fig.: Fig.: Contrast enhanced axial CT scan of liver reveals the thrombus in the
hepatic vein is extending into its insertion in inferior vena cava.
INDIA
Page 20 of 26
Fig.: Fig.: Contrast enhanced axial CT scan of liver reveals thrombosis of right branch
of portal vein in a case of ALA.
INDIA
Page 21 of 26
Fig.: Fig.: Ultrasound of liver reveals a caudate lobe ALA is causing compression of
IVC.
INDIA
Page 22 of 26
Fig.: Fig.: Contrast enhanced axial CT scan reveals a large ALA in right lobe of liver
causing IVC thrombosis.
INDIA
The ultrasound can be used in the follow up of ALA to monitor the size of ALA and its
complications.
Page 23 of 26
Fig.: Fig.: Ultrasound abdomen reveals a pigtail drainage catheter in ALA with specks
of air within.
INDIA
Page 24 of 26
Fig.: Fig.: Axial CT scan of liver reveals pneumobilia secondary to biliary
communication of abscess drained by a pigtail catheter.
INDIA
The abscesses which are likely to rupture are those in left lobe, multiple abscesses, those
more than 10cms in size and abutting the liver capsule. These abscesses require image
guided aspiration and/or pigtailing.
Conclusion
Page 25 of 26
The abscesses which abut the capsule, left lobe/multiple abscesses and are more than
10 cms in diameter are more likely to rupture. The USG guided pig tailing and aspiration
is effective in their treatment.
Imaging plays a vital role in the early detection; diagnosis and drainage of this potentially
lethal condition which if managed during initial course has complete recovery.
Personal Information
P.S.Naphade, Department of Radiology, SevenHills Hospital, Andheri east, Mumbai-59,

Maharashtra, INDIA.
Email- prashant.nafade@gmail.com
References
1. VanSonnenberg E, Mueller PR, Schiffman HR, Ferrucci JT Jr, Casola G, Simeone

JF, Cabrera OA, Gosink BB, Intrahepatic amebic abscesses: indications for and results
of percutaneous catheter drainage, Radiology. 1985 Sep; 156(3):631-5
2. ShyamMathur, RS Gehlot, AlokMohta, NarendraBhargava, Clinical Profile of

Amoebic Liver Abscess, JIACM 2002; 3(4): 367-73
3. Radin DR, Ralls PW, Colletti PM, Halls JM, CT of Amebic Liver Abscess, AJR Am
J Roentgenol. 1988 Jun; 150(6):1297-301.
4. Singh V, Bhalla A, Sharma N, Mahi SK, Lal A, Singh P, Pathophysiology of jaundice

in amoebic liver abscess, Am J Trop Med Hyg. 2008 Apr;78(4):556-9.
Page 26 of 26

Abs Hepatico Amebiano

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Abs Hepatico Amebiano

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Amoebic liver abscess (ALA) and its complications:

Poster No.: C-1139

Intestinal amoebiasis is caused by a protozoan Entamoeba Histolytica.

It occurs predominantly in young males. The most common presenting features of

Imaging findings OR Procedure details

On CT scan, the abscess appear hypodense to normal hepatic parenchyma with

Common complications are listed below.

Sub diaphragmatic collection

Rupture in pleural cavity

Rupture in pericardial cavity

Hepatic vein thrombosis

Portal vein thrombosis

Inferior vena cava(IVC) thrombosis

Fig.: Fig.: Ultrasound of abdomen excellently demonstrates the rent in diaphragm

P.S.Naphade, Department of Radiology, SevenHills Hospital, Andheri east, Mumbai-59,

1. VanSonnenberg E, Mueller PR, Schiffman HR, Ferrucci JT Jr, Casola G, Simeone

2. ShyamMathur, RS Gehlot, AlokMohta, NarendraBhargava, Clinical Profile of

4. Singh V, Bhalla A, Sharma N, Mahi SK, Lal A, Singh P, Pathophysiology of jaundice

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