Diagnosis and treatment of amebic “empyema”: Report of eighty-eight cases

Abstract

Eighty-eight patients with amebic “empyema” were treated during a fifteen year period. Rupture of the hepatic abscess into the pleural cavity was preceded by a clinical picture suggestive of an acute inflammatory process as short as three days or a chronic wasting disease as long as eight months. The complication was signaled by increase or change in character of pain, respiratory insufficiency, sepsis, and an opaque right lung field with mediastinal shift. Serologic tests and liver scans have allowed earlier diagnosis of the disease. Treatment included: (a) amebicidal drugs, singly or in combination, particularly metronidazole and emetine; (b) drainage of the pleural contents by closed or open thoracostomy, frequently followed by decortication and, in a few cases, by liver aspiration of undrained abscesses; and (c) treatment of associated respiratory, circulatory, and systemic derangements. Seventy-five patients were discharged as cured or improved; one had recurrence of the clinical picture of amebic abscess. Twelve patients succumbed due to respiratory failure, sepsis, and pulmonary edema; in three the disease was not correctly diagnosed during life. Prompt diagnosis and efficient therapy during the uncomplicated stage of hepatic amebic abscess should avoid this dreadful and potentially lethal complication.