Left upper quadrant collection

Case contributed by Ian Bickle

Presentation

Renal dialysis patient. Abdominal distension and fever.

Patient Data

Age: 45
Gender: Female
x-ray

The bowel is displaced in the left upper quadrant and flank.

Transverse colon appropriately sited in the upper abdomen.

Urinary catheter in situ.

Large left upper quadrant collection extending into the pelvis.

Fibroid uterus.

Solid organs normal.

Minor bibasal lung consolidation.

Case Discussion

This case is a good one to test the fellowship candidate, starting with the plain film.

The candidate should make a sensible description and differential for the appearances before 'earning' the right to suggest a further investigation ( CT or ultrasound ) to review further.

The CT is then presented with the opportunity for the candidate to report the findings of the CT and try to give a definitive diagnosis and potentially management plan.

In this case the candidate might highlight the amenability of the collection to ultrasound guided percutaneous drainage.

** of interest the splenic flexure is above the mass, which nearly excludes the commonest left upper quadrant mass, that of splenomegaly.

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