Subphrenic abscess, also known as subdiaphragmatic or infradiaphragmatic abscess, is localized accumulation of pus in the subphrenic spaces.
The typical presentation are:
- upper quadrant pain
Subphrenic abscess may be caused by:
- perforation of hollow viscus (for example, appendix, colon)
- inflammatory process (pancreatitis, cholecystitis, hepatic abscess, etc.)
- trauma of internal organs (stab, gunshots, etc.)
- as complication of surgical operations (splenectomy, cholecystectomy, gastrectomy, etc.), most commonly in 1-3 weeks after surgery
- idiopathic (no obvious reason) 3
Subphrenic abscess may be right-sided (between right hemidiaphragm and liver) or left-sided (between left hemidiaphragm and spleen), most often is right-sided 1.
In general, there is infradiaphragmatic localized collection of fluid with air bubbles or air-fluid level which has an enhancing wall. It is often combined with elevation of hemidiaphragm and pleural effusion.
Often the only finding on plain radiograph is elevation of hemidiaphragm 2. Also infradiaphragmatic collection of air (if present), pleural effusion can be detected.
Nonhomogeneous fluid-density mass in the infradiaphragmatic spaces which may contains echogenic debris, gas 4.
CT is good modality for detection of subphrenic abscess, estimating the volume. It allows to evaluate condititon of adjacent organs and possible reason of abscess (e.g. perforation) and his complications.
Treatment and prognosis
Without adequate treatment subphrenic abscess could lead to peritonitis, sepsis and death.
Treatment options include combination of antibacterial therapy and surgical drainage.
- 1. https://thorax.bmj.com/content/thoraxjnl/4/1/1.full.pdf
- 2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1502859/
- 3. https://www.jstage.jst.go.jp/article/jjsa/76/7/76_1633/_article/-char/en
- 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