Cardiac tamponade secondary to ruptured amoebic liver abscess

A young man in his 20s presented with shortness of breath for 2 hours, with a history of fever and abdominal pain for 10 days. On preliminary examination, he was visibly tachypnoeic and hypotensive, with a raised jugular venous pulse and muffled heart sounds. Additionally, there was profound tenderness in the right hypochondrium. Transthoracic echocardiography revealed a dilated, non-collapsing inferior vena cava and collapsed right-sided chambers of the heart, confirming the diagnosis of cardiac tamponade due to a massive, circumferential pericardial effusion (2.8 cm in maximum dimension). Subsequent drainage of the pericardial effusion was done using a 6-French pigtail catheter. Interestingly, the pericardial fluid appeared thick and greyish brown in colour, resembling a typical 'anchovy-sauce-like' appearance, raising the suspicion of a ruptured amoebic liver abscess with extension into the pericardium. Ultrasonography of the abdomen revealed a single, well-defined abscess on the left lobe of the liver (6 cm×5 cm×4 cm) with free communication into the pericardium. Contrast-enhanced CT of the chest and abdomen revealed transdiaphragmatic extension of the liver abscess into the pericardial cavity. Amoebic serology was reactive, and the wet mount microscopy was negative for Entamoeba histolytica The patient was managed conservatively with daily aspiration of the pericardial fluid from the pigtail, intravenous antibiotics and intravenous metronidazole for 10 days. Therapeutic pleurocentesis of the right pleural effusion was additionally carried out. He had a complete recovery with no sequelae and was subsequently discharged after 10 days.