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July 1981

Amebic Liver Abscess

Author Affiliations

Johnson City, Tenn

Arch Intern Med. 1981;141(8):1103. doi:10.1001/archinte.1981.00340080139039

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To the Editor.  —I was interested in the report in the Archives by Kovaleski et al (1981;141:132-134) on the diagnosis and treatment of amebic liver abscess. Having been trained at Madras, South India, where it is not uncommon to have at least one amebic liver abscess in the medical wards at all times, I would like to emphasize an important clinical sign that has impressed me by its specificity, namely, localized intercostal edema and tenderness.The combination of a subtle fullness in two or three intercostal spaces together with a dull-red blush and tenderness in a person who is febrile, especially if accompanied by right basal lung signs, has almost always turned out to be an amebic abscess in the right lobe of the liver. The only other condition that may mimic this is empyema, which is usually apparent on a decubitus film.This constellation of findings in an endemic

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