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The ultrasound appearance of subdiaphragmatic rupture of a right lobe liver abscess in a two-year-old child

Departments of Radiology and Paediatric Surgery, Faculty of Medicine, University of Natal, South Africa

This excerpt was created in the absence of an abstract.

Amoebic liver abscess is a common disease amongst the black population in the coastal region of Natal. All age groups may be affected and if diagnosedearly and treated properly the disease carries a good prognosis (Adams and MacLeod, 1977). We use ultrasound routinely for diagnosis and for accurateaspiration therapy. We report here the ultrasound appearances of an amoebic liver abscess which ruptured into the subphrenic space. To our knowledge this has not previously been described.

A two-year-old black child, weight 9 kg, was admitted with a one week history of fever, vomiting and passage of loose stools. On admission her temperature was 36.7°C and pulse 120 per minute. There were crepitations at the right base and the liver was enlarged and tender. Relevant investigations were: haemoglobin 7 g/dl, white cell count 7000/mm³ (neutrophils 46%, lymphocytes 40%, eosinophils 1 %), serum complement fixation test for ameobiasis positive, stools contained necrotic debris and mucous, but no blood. A chest radiograph (Fig. 1A) showed moderate elevation of the right diaphragm and linear actelectasis at the right base. Ultrasound examination of the liver (Fig. 1B)was performed in parasagittal sections with the patient lying supine. A 3.5 cm well defined transonic lesion was found lying posteriorly in the right lobe of the liver hemidiaphragm.

Received for publication May 1, 1979.