Intrathoracic presentation of amebic liver abscess

Area of Science:

• * Infectious Diseases
• * Surgical Gastroenterology
• * Pulmonology

Background:

• * Amebic infection, particularly amebic liver abscess (ALA), is endemic in tropical and subtropical regions, causing significant chronic morbidity.
• * Intrathoracic complications of ALA, such as empyema and lung abscess, can arise, posing diagnostic and therapeutic challenges.

Observation:

• * This report details 10 patients with intrathoracic ALA manifestations who underwent surgical treatment after conservative measures proved ineffective.
• * Presentations included empyema (5 patients), lung abscess (3 patients), and direct intrathoracic shadow (1 patient), with 9 cases linked to right lobe ALA and one to left lobe ALA with pericarditis.

Findings:

• * Conservative treatment failure in these cases is attributed to the viscous nature of amebic pus and intense pleural/pericardial inflammatory reactions.
• * Surgical drainage, specifically transpleural drainage, offers a direct approach to superiorly located right lobe ALA, proving safe when combined with antiamebic drug therapy.

Implications:

• * Early surgical intervention is advised for large ALAs unresponsive to conservative management to prevent severe pleuropulmonary amebiasis.
• * Transpleural drainage is a viable and safe surgical option for managing intrathoracic ALA complications, enhancing patient outcomes.