Computed tomography of silent abdominal abscesses

Area of Science:

• Radiology
• Abdominal Imaging
• Diagnostic Procedures

Background:

• Abdominal abscesses often present with nonspecific symptoms, complicating diagnosis.
• Typical signs like fever and leukocytosis may be absent, reducing clinical suspicion.
• Computed tomography (CT) is a key imaging modality for evaluating abdominal pathologies.

Purpose of the Study:

• To review computed tomographic (CT) findings in patients with clinically unsuspected abdominal abscesses.
• To highlight the challenges in diagnosing abdominal abscesses when classic signs are absent.
• To assess the diagnostic utility of CT and guided aspiration in these cases.

Main Methods:

• Retrospective review of nine patients with abdominal abscesses.
• Analysis of clinical presentations, CT findings, and diagnostic procedures.
• Correlation of imaging findings with confirmed abscess diagnoses.

Main Results:

• None of the nine patients had significant fever or leukocytosis.
• Localized pain or a palpable mass were the main clinical features in seven patients.
• CT demonstrated encapsulated fluid collections without gas in five chronic abscess cases.
• CT was diagnostic in three patients; guided aspiration aided diagnosis in two others.
• Four cases were misdiagnosed preoperatively due to low clinical suspicion, nonspecific CT appearance, or lack of aspiration.

Conclusions:

• Abdominal abscesses can present without classic inflammatory markers, necessitating a high index of suspicion.
• Computed tomography (CT) findings can be subtle or nonspecific, requiring careful interpretation.
• Diagnostic aspiration guided by CT is valuable when the diagnosis remains uncertain.
• Improved preoperative diagnosis requires integrating clinical suspicion with imaging and procedural data.