Amebic Liver Abscess

Plain Film Radiography

On plain film radiography, an amebic abscess of the liver (Fig. 1.49) is characterized by hepatomegaly and obscuration of the hepatic angle in both supine and erect views; ileus may be present, especially in 30% of patients with hepatic abscess who show signs of invasive colonic amebiasis (Fig. 1.50). The gallbladder may be dense and distended. This combination is not usually seen in a subphrenic abscess or hepatoma, but can occur occasionally in acute cholecystitis.

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Fig. 1.49 Amebic abscesses of the liver. (A) Multiple amebic abscesses in a fatal case. The necrotic tissue has been removed from one abscess, leaving a prominent cavity. Much of the liver is involved with adjacent inflammation. AFIP 58-4839-2. (B) Large abscess eroding through the dome of the liver. AFIP 203398-2. (C) Multiple trophozoites, inflammatory cells, and degenerating hepatocytes in an early amebic abscess. (D) Central necrosis in a liver abscess containing many amebic trophozoites and inflammatory cells. (E) Close-up view of multiple trophozoites. Note the typical ameboid shapes, granular cytoplasm, small round nuclei, and central karyosomes. X1400. AFIP 69-7841. (A from C. H. Binford, D. H. Connor (eds): Pathology of Tropical and Extraordinary Diseases).

Fig. 1.50 Hepatomegaly and ileus, a common combination of findings in hepatic and intestinal amebiasis.