Intra-abdominal abscesses radiology diagnostic Poster No.: C-2320 Congress: ECR 2012 Type: Scientific Exhibit Authors: K. Viksna; Riga/LV Keywords: Abscess, Computer Applications-Detection, diagnosis, Ultrasound, CT, Anatomy, Abdomen DOI: 10.1594/ecr2012/C-2320 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myesr.org Page 1 of 14
Purpose Intra-abdominal abscesses are localized collections of pus that are confined in the peritoneal cavity or retroperitoneal space by an inflammatory barrier [7]. The purposes of this study were: - to elucidate the most common abscesses causes and localization, - to analyze ultrasound (US) and computed tomography (CT) opportunities for the accurate diagnosis of intraabdominal abscesses. Methods and Materials Patients with intraabdominal (intraperitoneal and retroperitoneal) abscesses were identified by the hospital database. The imaging and clinical records were analyzed retrospectively. From September to December 2010, intraabdominal abscess was diagnosed 30 patients (22 women, age range 27-86 years and 9 men, age range 21-71 years). Results In 25 (83%) of the 30 patients abscess was localized intraperitoneal space, 5 (17%) of 30 patients - retroperitoneal (Fig.1). Page 2 of 14
Fig. 1: Abscesses localization References: K. Viksna; Riga, LATVIA Most common 48% or 13 patients intraperitoneal abscess was localized ileocaecal region; the second common localization was subhepatic space (clinical example fig.2) and pelvis (each 12% or 3 cases), the third (8% or 2 cases each) - mesenterico-colic space and perivesical (gallbladder)(fig.3). Page 3 of 14
Fig. 3: Intraperitoneal localization References: K. Viksna; Riga, LATVIA Retroperitoneal space abscesses was only 5 cases and was localized in posterior and anterior pararenal space, retrofascial space (Fig.4). Fig. 4: Retroperitoneal localization Page 4 of 14
References: K. Viksna; Riga, LATVIA Intraabdominal abscesses most common cause was appendicitis 44% or 11 cases (Fig.5). The second common cause was tumor of gastrointestinal tract (caecum and colon sygmoideum tumors) and acute cholecystitis 12% or 3 cases each. Fig. 5: Causes of intraperitoneal abscesses References: K. Viksna; Riga, LATVIA Causes of retroperitoneal abscesses were spondilodiscitis, acute pancreatitis, sarcoma retroperitonealis, chronic pyelonephritis (20% or 1 cases each causes) and one cases was unclear or primary (Fig.5). Page 5 of 14
Fig. 6: Causes of retroperitoneal abscesses References: K. Viksna; Riga, LATVIA 15 patients or 50% abscesses were diagnosed in operation, 13% or 4 patients diagnosis of abscess was made at US examination, but 37% or 11 patients - CT examination (Fig.7). Fig. 7: Primary diagnostic of abscesses References: K. Viksna; Riga, LATVIA Page 6 of 14
Fifteen patients who diagnosed abscess only in operation were made US examination 67% or 10 cases, US and CT examination 20% or 3 cases, but only 13% or 2 patients were not made examination (Fig.8). Fig. 8: Imaging befor operation References: K. Viksna; Riga, LATVIA Images for this section: Page 7 of 14
Fig. 1: Abscesses localization Page 8 of 14
Fig. 2: Subhepatic abscesses - fluid collections with enhancing rim, gas bubbles and fistulous tract Page 9 of 14
Fig. 3: Intraperitoneal localization Fig. 4: Retroperitoneal localization Page 10 of 14
Fig. 5: Causes of intraperitoneal abscesses Fig. 6: Causes of retroperitoneal abscesses Page 11 of 14
Fig. 7: Primary diagnostic of abscesses Fig. 8: Imaging befor operation Page 12 of 14
Conclusion The most common abscesses were localized in the ileocaecal region, the most common cause was acute appendicitis. The best diagnostic method for abscesses is CT examination with contrasted gastrointestinal tract and i/v contrast, it allow to diagnose the greatest part of intraabdominal abscesses. Abscesses diagnostic with US examination has limited, frequently it can disturb bowel gas. It is difficult to diagnose very small abscesses in radiology examination. References 1.Abdominal abscess available at http://www.scribd.com/doc/ 48656699/abdominalabscess 2.Federle MR. [et al.] Diagnostic imaging abdomen. - Altona: Amyrsis, 2004; I-1-6. 3.Feldman A, Friedman LS, Brandt JL. Sleisenger and Fordtrans's Gastrointestinal and liver disease. 9th ed. St. Louis: Saunders; 2010.p.412-414. 4.Morton A. Meyers. Dinamic radiology of the abdomen. 5th ed. New York: SpringerVerlag; 2000. p.57-63., p79. 5.Prokop M. CT of abdominal emergencies available at http://www.star-program.com/ resource.ashx/abstract/645 6.Renal and retroperitoneal abscesses. Urologysurgery 2009, January 6,available at http://urologysurgery.wordpress.com/2009/01/06/renal -and-retroperi toneal-abscesses-2/ 7.Saber A. Abdominal abscess, 2009, available at http://emedicine.medscape.com/ article/189468-overview 8.Silverman PM, Quint LE, Francis IR. CT of extraperitoneal space: normal anatomy and fluid collections. AJR. 1992; 159:933-941, available at http://www.ajronline.org/cgi/ reprint/159/5/933 9.Skucas J. Advanced imaging of the abdomen. London: Springer, 2006; p.877.-879. 10.Sutton D. Textbook of radiology and imaging. London, 2005; p.632.-633., 681.-682. Page 13 of 14
Personal Information Kristine Viksna, resident of Riga Eastern Clinical University Hospital, Department of Radiology, Riga Stradins University, Riga, Latvia e-mail: kvk@inbox.lv Page 14 of 14