CT differentiation of subphrenic abscess and pleural effusion

[Usefulness of chest sonography in a respiratory medicine unit]

Chest ultrasound, a diagnostic technique used mainly by radiologists, is useful for managing pleural effusion. Sonography and computed tomography (CT) are complementary, although the former is more accessible to clinicians because it is safe and easy to use and because results are available quickly. We evaluated the utility of chest sonograms in a respiratory medicine unit managed by pneumologists. During the period under study, requests for CT scans to manage complicated pleural effusions decreased as the use of sonograms increased. We conclude that ultrasound imaging is useful in the hands of pneumologists who use the technique to diagnose pleural effusions.

[Subphrenic abscess due to ectopic appendicitis]

BACKGROUND

Idiopathic subphrenic abscesses are uncommon in children. Standard chest X-rays may provide the suspicion of this diagnosis. Initial percutaneous drainage of the collection is usually performed. Surgery is required when the underlying cause remains unknown.

CASE REPORT

A 12-year-old boy presented signs of pulmonary abscess. Chest X-rays, ultrasonography and computed tomography established the diagnosis of a right subphrenic abscess, which was percutaneously drained. Surgery disclosed an ectopic appendiceal perforation.

CONCLUSION

In children, appendicitis is the main etiology of primary or postoperative subphrenic suppurations. Ectopic appendicitis is an important predisposing factor to this complication.

CT and MR in pleural disease

A number of different imaging modalities can be used in the assessment of pleural disease. Although ultrasound has been the more traditional method, CT has found increasing utility for the assessment of the empyema and loculated pleural fluid collections prior to drainage and the evaluation of benign and malignant pleural tumors. MRI has a limited but important role particularly in the evaluation of focal pleural tumors such as lipomas and in determining the extent of malignant mesothelioma prior to therapy.

The primary role of ultrasound in evaluating right-sided diaphragmatic humps and juxtadiaphragmatic masses: a review of 22 cases

Twenty-two successive patients presenting with localised humps on the right hemidiaphragm or juxtadiaphragmatic masses, as revealed on standard chest radiographs, were submitted for ultrasound examination. These were carried out irrespective of the patient's symptoms. Ultrasonography provided a useful adjunct to conventional chest radiography and accurately defined the extent of diaphragmatic humps and the contents of diaphragmatic herniations and juxtadiaphragmatic masses, clearly defining their relationship to the adjacent organs. In most cases further radiological investigations were unnecessary.