The silent abdominal abscess: role of the radiologist

An abdominal abscess usually causes severe distress with fever, leukocytosis, pain, and toxicity. However, a small but significant proportion of patients with abdominal abscess may appear entirely well with no elevated temperature or white blood cell count. Fifteen patients are reported whose initial clinical presentation was unremarkable but who had significant abscess formation that was well documented by radiographic methods. Both the radiologist and the patient's primary physician must be aware of the not infrequent presentation of abdominal abscess in a clinically innocuous manner. The lack of fever, elevated white blood cell count, or patient complaint should in no way rule out the diagnosis of abscess when positive radiographic evidence is found.