Greetings of the day!
Today another story from Saudiarabia
Down the track of Memories
King Abdul Aziz specialist hospital Taif Saudi Arabia
On another occasion, Mr Zahrani (name changed), a 43 year old business man presented with right upper abdominal pain associated with loss of appetite of ten days duration.
Clad in long Abaya, the anxious wife of Mr. Zahrani kept her dazzling, branded ladies purse aside and pulled the CT scan report of her beloved husband and a referral note.
"Daktoor( doctor) we are worried" ,she said.
The CT scan abdomen was suggestive of a hyper dense lesion in the segment V of liver and the concerned radiologist had mentioned lot of differentials below for further studies.
The differentials varied from a benign to malignant lesions of the liver.
Loss of appetite was a worrying clinical symptom in this patient and Mr Zahrani was admitted for further evaluation.
The family was counselled about fine needle aspiration of this hyperdense lesion in the liver .
Next morning, in the wee hours we shifted the patient to the radiology dept. The fine needle aspiration was carried out under all aseptic precautions . The slides were immediately prepared by Mr Farooq Ahmad senior Microbiology technologist who was working as supervisor of this CAP accredited laboratory.
Soon after the procedure our team went to attend the morning report meeting in the blue colored Adminstrative block of the hospital . The morning report used to be a great learning activity in the hospital as over night admissions were briefed in this meeting in front of all medical specialities, followed by discussion of one interesting case.
That day our patient was discussed .
The house was fully in support of a malignant lesion in this patient and all were of the opinion to have Fine needle aspiration for the final diagnosis.
Soon after the meeting we straight away went to the Microbiology dept in the ground floor of the hospital and we met Dr Manzoor Ahmad Banday, the senior microbiologist.
Dr Manzoor pulled up his specs and went on demonstrating the slides of the patient on a, 3 headed teaching microscope of the Dept.
"Look! This is a classical anchovy sauce pus and these are swarming Entameobea histolytica" while focusing minutely on the high power of the microscope Dr Manzoor said . There is neither malignancy nor metastasis, he jubilantly concluded.
The hyperdense lesion was a solid organized abscess which had sparkled doubts of malignancy /metastasis in the treating team and the radiologist.
CT image was not a classical abscess.
We were thrilled to break this happy news to the family.
Normally the diagnosis of Amoebic liver abscess is quite straight forward in an endemic area but in a hyperdense lesion other differentials need to be considered.
Amoebic liver abscesses are rare in Saudi Arabia because there is excellent sanitation and a stringent quality control of restaurants. These liver lesions develop due to poor sanitation and unhygienic conditions. The transmission from restaurants is well known.
The patient was started on Metronidazole and 10 days later Mr Zahrani happily went his home.
Dear Friends : This case emphasizes the importance of fine needle aspiration which is a safe and useful diagnostic procedure for evaluating various lesions in Liver, spleen and other organs of the body.