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An enlarged, tender liver and respiratory symptoms in a patient from an area where E histolytica is endemic would be highly suggestive of pleuropulmonary amebiasis. Unfortunately, the abdominal examination often is unhelpful in such patients. Laboratory abnormalities are nonspecific and include leukocytosis, anemia, an elevated sedimentation rate and abnormal alkaline phosphatase and transaminase values. However, all or many of these tests may be normal in pulmonary amebiasis. Chest roentgenograms commonly show an elevated and poorly mobile right diaphragm, right lower lobe consolidation, infiltrates or pleural effusion. Cardio-megaly, if present, may indicate pericardial effusion. The Mexican hat sign, an exotic radiographic anomaly, may be present, but is not pathognomonic. Lung abscesses usually involve the right lower lobe, but occasionally one or both lungs may be affected. Ultrasound, the imaging method of choice for an amebic liver abscess, may reveal findings highly suggestive of the diagnosis, particularly in endemic areas. These abnormalities are a round- or oval-shaped lesion, poorly echogenic areas in the normally echo-genic liver parenchyma, continuity with the liver capsule and distal sonic enhancement. Usually there is just a single lesion in the right lobe. A hypoechogenic liver lesion that has disrupted the diaphragm is a helpful sign of pleuropulmonary involvement.