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Amebic Abscess

Faye C Laing, MD

March 28, 1994

Presentation

A 25-year-old man developed malaise, fever, and increasing right upper quadrant discomfort two weeks after returning home from vacation.

Imaging Findings

Initial Ultrasound Study
Second Study

Ultrasound shows a poorly defined, 4-5 cm hypoechoic liver mass. Its walls are poorly defined, and sound transmission is poor.

A second study 48 days later reveals that the mass has become slightly larger and has developed increased internal echogenicity with better defined walls and improved sound transmission.

Diagnosis

Amebic abscess

Discussion

This patient had an amebic abscess that responded to therapy. At the time of presentation, the abscess contained thick, proteinaceous material (sometimes described as resembling "anchovy paste"). The appearance of the first scan, therefore, was inconsistent with a cystic mass and was more suggestive for a solid process. In light of the patient's history (he had recently returned from Mexico), an amebic abscess would be a likely diagnosis. Serial amebic titers rose rapidly, and he symptomatically improved following metromidazole (Flagyl) therapy.

An amebic abscess typically takes several weeks/months to resolve, and its sonographic appearance becomes increasingly cystic as it resolves. Ultimately, it shrinks in size and disappears, but on rare occasions, it may not completely involute and a residual cyst may remain.

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