Upper abdominal abscess: a continuing and deadly problem

Subphrenic and other upper abdominal abscesses continue to be associated with high mortality, even in today's era of broad spectrum antibiotics and sophisticated surgical techniques. Most cases represent complications of intraabdominal surgery. Because the clinical presentation is often subtle and nonspecific, the radiologist plays a paramount role in early diagnosis. Conventional radiography remains an effective method in the initial detection of upper abdominal abscesses. In this study, radiographs were reviewed in 82 patients. In retrospect, plain films revealed extraluminal gas or soft-tissue mass due to abscess in 58 patients (71%). Of these, the abscess was accurately reported initially in 42 patients, but it was initially missed in 16 patients. Conventional gastrointestinal contrast studies, which were underutilized, proved extremely accurate in demonstrating abnormality, especially in the left upper abdomen. Computed tomography, gallium scanning, and ultrasound were effective confirmatory procedures in many cases.
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