Amoebic pericardial effusion--diagnosis suggested by ultrasonography.

A 35 years old male presented with a two months history of progressively increasing dyspnoea. On examination he was in respiratory distress, afebrile, had prominent neck veins and an increased area of cardiac dullness. The heart sounds were muffled, and the abdomen was unremarkable except for an enlarged, tender liver. The blood count was normal, but the ESR was raised (60mm). X-ray chest showed an enlarged heart shadow. A clinical diagnosis of a pericardial effusion was made and he was sent to this Centre for echocardiography which showed a large pericardial effusion with a swinging heart (Figure 1). A routine upper abdominal ultrasonography study revealed a 9cm hypoechoic, oval lesion with a strongposterior enhancement in the left lobe of the liver. There were dilated tubular structures nearby (Figure 2). The appearance was that of a left lobe liver abscess. The concurrence of these findings prompted us to suggest a diagnosis of an amoebic liver abscess leading to pericardial effusion. Aspiration of both the pericardial cavity and the liver lesion yielded identical pinkish fluid. The fluid was sent for pathological examination and though vegetative amoebae were not found, the pathologist agreed with our impression of an amoebic etiology on the basis of the gross appearance. Serological tests for amoebiasis were, however, strongly positive. The patient was put on antiamoebic drugs and had a rapid response. Subsequent examinations showed lessening of both the pericardial and hepatic lesions and by five months of follow-up, there was complete resolution.