Chest
Thoracic Complications of Amebic Abscess of the Liver: Report of 501 Cases
Section snippets
CLINICAL MATERIAL
Five hundred one cases of AAL with thoracic complications were studied from May 1961 to September 1979, representing all cases with thoracic complications seen at our hospital during this period (Table 1). Ages ranged from 4 to 84 years; 67 percent were male; 175 had inflammatory reactions of neighboring structures, 326 had rupture of AAL into the chest contents. Four percent of the complications were left-sided. Most of the cases were preceded by a clinical picture, diagnostic or at least very
RESULTS
Our 18-year cumulative mortality is a little more than 8 percent; for cases with inflammatory reactions, it has been 2.3 percent; for those rupturing into the chest, the average is 11.4 percent, ranging from 5.2 percent for the least malignant, rupture into the airways, to 60 percent for those into the pericardium (Table 3).
Causes of death included sepsis, respiratory insufficiency, shock, massive aspiration of liver contents, tamponade, and pulmonary edema; in a few cases more than one cause
COMMENTS
In previous reports, considerations of pathogenesis, diagnosis, and treatment of several of the types of thoracic complications of AAL were made;1, 2, 3, 4, 5, 6, 7, 8, 9 others seem pertinent at this time.
In this era of mass movement of populations in and out of areas with poor sanitary conditions, more cases of AAL and its thoracic complications are being seen in countries where they were previously uncommon, both in aliens and natives, in children and adults.
As classified by others,10, 11
CONCLUSIONS
Three sequential questions should be raised in every case of pathology of the lower chest, right or left, or of the pericardium: (1) Is there an AAL present? (2) Is there a thoracic complication of AAL? (3) If present, is the complication inflammatory or secondary to rupture of AAL into the chest? If these questions are raised and answered satisfactorily, earlier diagnosis and prompt therapy should improve the results of this series. Treatment must include the following: (1) amebicidal drugs,
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