Diagnosis and treatment of amebic “empyema”

Parasitic Infections of the Pleural Space

“…The clinical presentation of amebic empyema develops on a background of hepatic amebiasis (Table 1). In a review of 88 cases of amebic empyema, Ibarra-Perez 28 found that all patients had symptoms attributable to a liver abscess for 3 days to 8 months prior to the onset of thoracic manifestations. 28 Empyema is typically heralded by the onset of chest pain, dyspnea, and cough.…”

“…In a review of 88 cases of amebic empyema, Ibarra-Perez 28 found that all patients had symptoms attributable to a liver abscess for 3 days to 8 months prior to the onset of thoracic manifestations. 28 Empyema is typically heralded by the onset of chest pain, dyspnea, and cough. Although often insidious in onset, rupture of the diaphragm may be a dramatic event, with a sudden tearing sensation and pain radiating to the shoulder or scapula, followed by severe dyspnea, toxicity, and shock.…”

“…Although often insidious in onset, rupture of the diaphragm may be a dramatic event, with a sudden tearing sensation and pain radiating to the shoulder or scapula, followed by severe dyspnea, toxicity, and shock. 8,16,17,[28][29][30][31] Hemoptysis has been described, [29][30][31] and a cough productive of "anchovy sauce" or bile-stained sputum is indicative of a hepatobronchial fistula. 6,[17][18][19]23,29,31 Most patients do not have a history of diarrhea.…”

“…With rupture of a large abscess, there may be complete opacification of the right hemithorax, and a mediastinal shift may be evident 243 (tension pyothorax). 28 When smaller effusions are present, the features of intrapulmonic amebiasis may be discernable. A characteristic "shark's fin" lower lobe infiltrate has been described, consisting of a triangular opacity based on the diaphragm with the apex curving toward the hilum.…”

“…This method usually will be successful, but open drainage may be required for loculated pus and decortication may be necessary in a minority of cases. 8,17,28,31,32,39…”