Inferior vena cava thrombus with pulmonary embolism complicating amebic liver abscess

Excerpt

Amebic liver abscess leading to hepatic vein thrombus is described, but pulmonary embolism is exceedingly rare [1, 2]. This 50-year-old male presented with fever, upper abdominal pain since 10 days, chest pain, and breathlessness since 2 days. There were tachycardia, tachypnea, and tenderness in the right upper abdomen. Leukocyte count was 27,000/mm³, and liver function tests were normal. Indirect hemagglutination test for amebiasis was positive. On ultrasound, there was a 7.7 cm × 5.4 cm abscess in segment 8 of the liver and a thrombus in the right hepatic vein extending into the inferior vena cava. Computed tomography (CT) scan of the abdomen showed a liver abscess with thrombus in the right hepatic vein and inferior vena cava (Fig. 1) and thrombus in the first segmental branch of the right pulmonary artery (Fig. 2) with no infarction. Treatment was with percutaneous aspiration, metronidazole, and low molecular weight heparin with which symptoms resolved in 2 weeks with a resolution of the pulmonary thrombus on follow up CT.

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