A 50 year old man who spent 4 weeks in rural India, returning about 12 weeks ago presents with one week of acute onset fever (39.0 C) and RUQ abdominal pain. His only other medical condition is severe COPD requiring chronic steroid use. On review of systems, he denies diarrhea. On exam, you do not note jaundice but there is hepatomegaly and point tenderness over the liver. Labs show a leukocytosis without eosinophilia, elevated alkaline phosphatase, and elevated hepatic transaminases.
Here is a CXR:
Given those findings, you order an abdominal CT. Here's one slice:
The microbiologist says, "Aha!" He pulls out the textbook you used for first and second year of medical school and shows you this image:
That's the cyst!Challenge: Now, if you were going to do a needle aspiration of this lesion, there is a "classic description" of the color and quality of the aspirate. What is it?
First two images shown under Fair Use. Third image is in the public domain.
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3 comments:
is it the paste of an ingredient that doesn't belong on pizza
Is it 'anchovy sauce' aspirate?...amoebic liver abscess
haha, yes to both answers. I'm not sure who thought of anchovy on pizza anyway.
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Cyst I
Entamoeba histolytica is a protozoan disease that exists as a cyst stage (infectious) and a trophozoite stage (invasive disease). The majority of infections occur in developing countries due to poor socioeconomic conditions and sanitation. Most infections are asymptomatic, but here, an amebic liver abscess from ascent of the portal venous system is described. 70-80% of the time, there will be a single abscess in the right lobe of the liver. Negative serology excludes infection, but a positive serology may be incidental. Needle aspiration is usually not required but would give an “anchovy paste” chocolate colored fluid from necrotic hepatocytes.
Sources: UpToDate; Medscape; Wikipedia.
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