A 45 year old female presents with 48 hour history of right upper quadrant pain, dyspnea, non-productive cough, fever with chills and rigor. The pain radiates to right shoulder tip. She has history of perforated duodenal ulcer repair 3 weeks ago. Temperature 39.3degC. O/E there is acute tenderness over right hypochondrium. CXR shows right sided pleural effusion. Diagnosis
Ans. (b) Subphrenic abscessRef: Bailey 26th edition Page 977* Bailey says- "Pus Nowhere, Pus Some where- search Pus Under the Diaphragm"* In a post op case (patient lying)- most dependent site of abscess formation is Subphrenic Space
Acute pancreatitis
Subphrenic abscess
Acute cholangitis
Pyonephrosis
Miscellaneous