Computed tomography in the diagnosis and management of abdominal abscesses

Abstract

Computed tomography (CT) is effective in demonstrating abdominal abscesses and their relation to surrounding structures. The CT signs of abscess are not unlike those demonstrable radiographically and include an abnormal mass, obliteration and displacement of surrounding organs, inappropriate gas, and peripheral enhancement after intravenous contrast. Axial imaging permits selection of safe approaches through which percutaneous needle aspiration can be performed for diagnosis and therapy. When techniques similar to those employed in angiography are used, a catheter can be inserted, the abscess evacuated, and the catheter left in place as a drain. Combined with intravenous antibiotics, this method of abscess drainage has been successful in curing abscesses without surgery. Representative examples are shown.

Retroperitoneal abscess: A presentation of colon carcinoma

“…Less common manifestations include perforation and abscess formation, which are usually intraperitoneal, but may also be located in the extraperitoneal spaces. Initial diagnostic evaluation may consist of the newer imaging modalities such as computerized tomography (CT) or ultrasound which will show the extent of the mass or infection [2][3][4]. Percutaneous aspiration and indwelling catheter drainage combined with antibiotic therapy may be immediately instituted without further diagnostic work-up to identify the source of infection.…”

CT appearance of giant colonic diverticulum

“…This calcification is presumably secondary to the chronic inflammation within the wall of the abscess, similar to that seen in other forms of chronic abscess formation [4]. The lack of enhancement may also be due to the chronic nature of the inflammation [5]. However, the thick wall, with an irregular outer margin, identified best by CT, may be due to the acute inflammatory component of GCD, similar to the CT appearance of acute diverticulitis, and may account for the accompanying abdominal pain and fever [6].…”

Computed tomography of intraperitoneal abscesses

“…Intraperitoneal-extraparenchymal abscesses show nearly homogeneous values between 15 and 35 HU if no hematoma is present. Gas in abscesses can be detected accurately with CT [4][5][6][7][8]. Pathophysiological causes include gas-producing bacteria, fistulas, or the results of punctures and drainages.…”

“…CT detects, localizes and in many cases shows the cause of intraperitoneal fluid collection when used in conjunction with the morphological criteria. CT-guided fine-needle puncture gives further clarification [6][7][8].…”

“…In patients with possible abscesses, computed tomography (CT) provides detailed quantitative and qualitative information on anatomical and pathological structures, even in seriously ill patients [4][5][6][7][8][9].…”