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July 21, 1978

Diffuse Colitis With Right Upper Quadrant Mass

Author Affiliations

From the Department of Radiology, Jewish Hospital of Cincinnati (Dr Rosenberg) and the University of Cincinnati Medical Center (Dr Tocino), Cincinnati.

JAMA. 1978;240(3):263-264. doi:10.1001/jama.1978.03290030081033

History  A 37-year-old woman was admitted to the hospital because of recent generalized myalgia, fever, and abdominal pain. There was a history of chronic diarrhea for at least three years, with four to six liquid brownish stools per day, without gross blood. Palpation of the abdomen demonstrated considerable tenderness throughout the right side. Rectal examination was painful. There was occult blood (1+) in the stool. The temperature on admission was 38 °C; the hemoglobin level, 6.5 g; and the WBC count, 20,000/cu mm.A plain film of the abdomen (Fig 1) and a diatrizoate (Hypaque) enema examination (Fig 2) were obtained.On the following day, the patient's symptoms became worse and more localized to the right upper quadrant of the abdomen. The temperature rose to 39 °C.

Diagnosis  Diffuse amebic colitis with ruptured amebic abscess of the liver.The plain film (Fig 1) demonstrates gaseous distension of small-bowel loops in