Introduction
Earlier I had described solid amoebic liver abscess based on my experience at the autopsy and isotope imaging. [1,2] At that time, some of my collegues raised eyebrows at my labelling an abscess as "solid". I describe below further five cases.

Material & Methods
During the last seven years from my clinic and cases admitted to Jaslok Hospital, I collected five cases of amoebic liver abscess who—

1. Had positive serological tests (l.H.A. in titre of > 1: 250)
2. Had cold areas on isotope liver scan
3. Whose sonography showed a sonodense lesion in the liver (Fig. 1, Fig. 2). With 13 number wide needle, diagnostic tapping was tried in these patients. Only in one patient 2 ml. of thick pus was aspirated. In the rest, tapping was negative.

The above patients were treated with injections of Emetine and a course of Metronidazole or Tinadazole. All the five patients recovered completely and the follow up imaging done after four months by either isotope liver scan or sonography showed a complete disappearance of the lesion.

Discussion
CT Imaging of pancreas has shown that after an attack of acute pancreatitis, modern imaging can differentiate between the complications of an abscess, pseudo-pancreatic cyst and phlegmon. The last is a "solid" inflammatory mass. In our country the other common solid inflammatory mass in the liver is tuberculoma. At times this can mimic solid amoebic liver abscess very much. Solid hydatid cyst (without secondary infection) of the liver has also been described recently. [3] Similarly modern imaging has confirmed my impression that amoebic abscess can be solid.

Discussion
Solid S.O.L. can occur in the liver in amoebic or tuberculous infections (Fig. 3). Unfortunately, serological tests for amoebiasis have not become available all over our country. Also I.H.A. test done commonly is very sensitive, but not specific. Not only it could be falsely positive, even when positive, at least one more test like C.I.E.A. test or Fluorescence antibody test should also be done.
Similarly in our country, in adults, Mantoux test does not help in diagnosis. So often we see 12-16 mm. positive without any active kochs focus in the body.
A Therapeutic test for amoebiasis in this situation may be worthwhile. But it must be kept in mind that solid amoebic abscess is a rare type of amoebic abscess. Also solid tuberculoma is a rare type of hepatic tuberculosis where not only full antikochs treatment will be required, but surgical enucleation of this mass may be required, since in our experience, this much mass, unlike in the case of brain tuberculoma, would not dissolve with antikochs drugs.
Therefore, patients having a solid S.O.L. in the liver should be investigated thoroughly in big medical centres. Serological tests for amoebiasis must be done. Laparoscopy can also be done in such patients and the mass can be biopsied. In other cases, presence of small tubercles elsewhere in the liver or specially on the peritoneum or the other viscera would click the diagnosis as against an amoebic pathology. Adhesions around the mass would possibly differentiate from lymphoma or other malignant deposits.
This patient's experience also shows that if the patient does not respond within 2 to 3 months of starting antikochs therapy, surgical treatment should not be delayed in such type of liver tuberculosis.

Summary
A case of solid tuberculoma of the liver as a case of S.O.L. has been presented. It has been discussed that how closely, it can mimic solid amoebic abscess. It has also been shown that such patients may need surgical treatment, when at laparotomy the whole mass can be enucleated.

Acknowledgement
I am grateful to Dr. N. H. Keswani, Medical Director, Jaslok Hospital, & Research Centre, Bombay for allowing me to publish this material

KAPOOR 0P : Hepatic Tuberculosis. Bulletin of the Jaslok Hospital & Research Centre 2: 32: 1976.

LELE RD, KAPOOR 0P, KAKKAR VC, CHITALE, ARUN : Fever of obscure origin Bulletin of the Jaslok Hospital & Research Centre, 1: 18: 1976.
In fact this diagnosis is a very responsible one and should not be made without a positive serological test. Fortunately, these tests are now easily available.
Earlier I had described eighteen cases of solid amoebic liver abscess. [l] At the autopsy, these lesions mimic deposits of lymphoma, malignancy or tuberculomas (Fig. 3). In our country, since tuberculosis of liver can also result in pyrexia, hepatic discomfort and hepatic enlargement, if a S.O.L. is seen on imaging, a tuberculoma can easily be mistaken for a solid amoebic liver abscess.
Pai [2] had earlier confirmed my finding of a solid amoebic liver abscess. I have now confirmed beyond doubt that like a pancreatic phlegmon, amoebic infection can be solid too. More the reason, that in our country, we should increase availability of serological tests for amoebiasis. With the result, that in future, moment any solid S.O.L. is seen in the liver, with a clinical picture and a positive amoebic serological test, antiamoebic drugs should be started.
Also I must add that in a number of patients of amoebic liver abscess, "part" of the mass seen on sonography is hyperechoic (solid) .

Summary
Five cases of solid amoebic liver abscess confirmed by sonography are presented. It is stressed that in our country, serological tests for amoebiasis should be used freely, not to mistake other solid lesions in the liver specially tuberculoma.

Acknowledgement
I am grateful to Dr. N. H. Keswani, Medical Director, Jaslok Hospital & Research Centre, Bombay for allowing me to publish this material.

References

1. KAPOOR 0. P.: A. L. A. S. S. Publishers, Bombay, 156: 1979.
2. PAI R. R. quoted by KAPOOR 0. P.: S. S. Publishers, Bombay 157, 1979.
3. EVANGELOS E. D.: et al Varied sonographic patterns in Echinococcus liver diseases. J. Clin Ultrasound 13: 627, 1985.