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Images of Memorable Cases: Case 80

Module by: Herbert L. Fred, MD, Hendrik A. van Dijk

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Case_80-pres1-1.jpg

Chest radiograph of a terminally ill 44-year-old man with a five-month history of intermittent fever and cough productive of yellow, blood-tinged sputum. On physical examination, he had a big liver and evidence of substantial weight loss. He died shortly after admission.

80. Bilateral pulmonary amebiasis

Autopsy disclosed numerous bilateral pulmonary abscesses, up to 15 cm in diameter. The right hepatic lobe also contained a single large abscess that had eroded into the right hepatic vein. The diaphragm was not involved. Countless amebic trophozoites were evident in the walls of the hepatic and pulmonary abscesses. While penetration of a hepatic abscess through the diaphragm is the usual route of amebae to the lungs, this case illustrates that amebae can also reach the lungs by entering the blood stream directly, the diaphragm remaining intact.

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