35-year-old patient:
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- Presenting with right flank pain and elevated CRP
- CT in portal venous phase was performed
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What is your diagnosis and what patient information will lead you to the correct pathogenesis?
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- Subphrenic abscess with focal calcification, history of prior appendectomy
Explanation:
Lost appendicoliths (as well as gall stones) can cause delayed abscesses years after the surgical procedure. Due to a tilted position of the patient during surgery, the lost stones may “travel” towards the upper abdomen and can cause abscesses in the Morison pouch.
Therapy consists of surgical or interventional removal of the stone and drainage of the abscess.
References:
– Singh AK, Hahn PF, Gervais D, Vijayraghavan G, Mueller PR. Dropped appendicolith: CT findings and implications for management. AJR Am J Roentgenol. 2008 Mar;190(3):707-11. doi: 10.2214/AJR.07.2917. PMID: 18287442.
Renal perforation secondary to calculous pyelonephritis, complicated by abscess formation.
Abscess