A subphrenic abscess, also known as a subdiaphragmatic or infradiaphragmatic abscess, is a localized accumulation of pus in the subphrenic space(s).
The classical clinical presentation is:
- upper quadrant pain
Subphrenic abscess may be caused by:
- perforation of hollow viscus (e.g. appendix, colon)
- inflammatory process (pancreatitis, cholecystitis, hepatic abscess, etc.)
- trauma of internal organs (stab, gunshots, etc.)
- a complication of surgical operations (splenectomy, cholecystectomy, gastrectomy, etc.), most commonly in 1-3 weeks after surgery
- idiopathic 3
A subphrenic abscess may be right-sided (between right hemidiaphragm and liver) or left-sided (between left hemidiaphragm and spleen), right-sided subphrenic abscesses are more common 1.
In general, there is an infradiaphragmatic localized collection of fluid with gas bubbles or gas-fluid level which has an enhancing wall. It is often combined with elevation of the hemidiaphragm and a pleural effusion.
Often the only finding on a plain radiograph is an elevation of the hemidiaphragm, 2 also infradiaphragmatic collections of gas (if present) and/or pleural effusion may be detected.
Non-homogeneous fluid-density mass in the infradiaphragmatic spaces which may contain echogenic debris and gas 4.
CT is a good modality for the detection of a subphrenic abscess and estimating its volume. It allows the evaluation the condition of adjacent organs and a possible reason for the abscess (e.g. perforation) and its complications.
Treatment and prognosis
Without adequate treatment, a subphrenic abscess may lead to peritonitis, sepsis, and even death.
Treatment options include a combination of antibacterial therapy and surgical drainage.
- 1. Harley, H. R. S. (1949). Thorax, 4, 1. https://thorax.bmj.com/content/thoraxjnl/4/1/1.full.pdf
- 2. Mottram ME. Subphrenic abscess: roentgen considerations. (1967) California medicine. 107 (1): 20-5. Pubmed
- 3. 吉田 佐智子, 横山 邦雄, 西田 十紀人, 生田 肇. 原因不明の横隔膜下膿瘍の1例. (2021) 日本臨床外科学会雑誌. 76 (7): 1633. doi:10.3919/jjsa.76.1633
- 4. https://books.google.com.ua/books?id=Ut_167qArOsC&pg=PA234&lpg=PA234&dq=subphrenic+abscess+ultrasound+appearance&source=bl&ots=IeXPyJfgGT&sig=ACfU3U1I5HPE-mx4MKGcjFmx1Q_gVjJ_2Q&hl=ru&sa=X&ved=2ahUKEwingZ2MjNTgAhXIqIsKHdzqCooQ6AEwE3oECDkQAQ#v=onepage&q=subphrenic%20abscess%20ultrasound%20appearance&f=false
- 5. Gopala K. Ravi, Yana Puckett. Subphrenic Abscess. (2020) Pubmed