Chest
Volume 79, Issue 6, June 1981, Pages 672-677
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Thoracic Complications of Amebic Abscess of the Liver: Report of 501 Cases

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During an 18-year period, 501 cases of thoracic complications of amebic abscess of the liver were studied; 175 had inflammatory reactions of thoracic structures (165 with pleural effusions and pneumonitis, ten with pericarditis) and 326 ruptured through the diaphragm (175 into the airways, 106 into the pleural cavity, 5 into the pericardium, 39 into the airways and pleura, and 1 into the pleura and pericardium). The thoracic complication was preceded by a picture suggesting an acute inflammatory process or a chronic wasting disease. Depending on type, the complication itself was signaled by increase or change in character of right upper abdominal or lower thoracic pain, dyspnea, or overt respiratory insufficiency, hemoptysis, and expectoration of necrotic material, sepsis, tamponade, and shock. Chest roentgenograms showed small to massive pleural effusions, basal pneumonitis, and cardiomegaly; serology, liver scans, and induced pneumoperitoneum were diagnostic. Treatment included metronidazole and emetine, drainage of pleural or pericardial contents or promotion of bronchial drainage, and meticulous care of associated respiratory, circulatory, and systemic derangements. Mortality for cases with rupture was 11.4 percent, due mainly to sepsis, shock, respiratory insufficiency, and tamponade. The rest of the patients were discharged in cured or improved condition.

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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,

REFERENCES (21)

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