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PubMed2005

Oral Campylobacter species involved in extraoral abscess: a report of three cases.

Oral Campylobacter species are rarely reported to cause extraoral infections. Here we present three cases of extraoral abscess caused by an oral Campylobacter sp. and a Streptococcus sp. The Campylobacter species were all isolated anaerobically and identified by sequencing analysis of the 16S rRNA gene. The cases included a breast abscess caused by Campylobacter rectus and a non-group A beta-hemolytic streptococcus in a patient with lymphoma, a liver abscess caused by Campylobacter curvus and an alpha-hemolytic streptococcus in a patient with complicated ovarian cancer, and a postobstructive bronchial abscess caused by C. curvus and group C beta-hemolytic Streptococcus constellatus in a patient with lung cancer. The abscesses were drained or resected, and the patients were treated with antibiotics with full resolution of the lesions. The C. curvus cases are likely the first reported infections by this organism, and the C. rectus case represents the second such reported extraoral infection.

Abscess↗
PubMed1994

The changing clinical spectrum of liver abscess: the Jerusalem experience.

A retrospective study was conducted of all 31 patients with liver abscess admitted to Shaare Zedek Medical Center between 1979, the year computed tomographic scan and ultrasound were introduced, and 1992. Fever and abdominal pain were the most common symptoms. Duration of symptoms was short: 81% of patients had symptoms for < or = 5 days and none had symptoms for more than 3 weeks. Amoebic abscess was found in one patient only, the remainder were pyogenic. Biliary tract pathology remains the most common cause of liver abscess (39%). The diagnosis was made by ultrasound in 22/31 (71%) and by computed tomographic scan in 9/31 (29%) of patients. Treatment consisted of intravenous antibiotics and percutaneous drainage under ultrasound guidance in 24/31 patients (77%). Four patients died (13%), three of whom had underlying malignancies. Clinical features were compared with those from a similar series of 36 cases with liver abscess reported from Jerusalem predating ultrasound and computed tomographic scan (1967-1977). Several major changes have occurred. First, the relative incidence of amoebic abscess has dramatically decreased. Second, ultrasound and computed tomographic scan have facilitated earlier diagnosis and percutaneous drainage, contributing to improved survival and lower morbidity.

Adolescent↗
PubMed1977

Ultrasonic distinction of abscesses from other intra-abdominal fluid collections.

The nature of 103 intra-abdominal fluid collections examined by ultrasound was determined by autopsy, needle aspiration, spontaneous drainage or surgical exploration. Abscesses, chronic hematomas, lymphoceles, urinomas, cysts and fluid-filled bowel loops are all approximately elliptical or circular in cross section. Collections of ascites have a very irregular outline. Bowel loops appear as multiple circles, all of similar size. Chronic hematomas contain strongly echoing material, while lymphoceles, urinomas, renal and hepatic cysts and collections of ascites are echo-free. Ovarian cysts into which there has been bleeding may contain echoes. The walls of abscesses, chronic hematomas, and bowel loops are less sharp than the walls of other collections. Intrahepatic abscesses may have more ragged walls than abscesses elsewhere. Ultrasonic characteristics of abscesses and hematomas overlap. It is sometimes possible to distinguish the nature of the fluid by its ultrasonic properties, but atypical appearances are not rare.

Abdomen↗
PubMed1989

Percutaneous drainage of chest abscesses in children.

Seven patients ranging in age from 3 to 18 years underwent percutaneous drainage of eight intrathoracic abscesses. Five of the abscesses were mediastinal or paramediastinal and resulted from esophageal perforation or esophageal anastomotic leakage. The abscesses resolved in each case, with a mean catheter drainage time of 28 days and no need for surgical intervention. Three of the abscesses were intrapulmonary, and each lay adjacent to a pleural surface. All three lung abscesses resolved within 19-24 days, without thoracotomy or wedge resection.

Abscess↗
PubMed1994

Hepatic abscesses: MR imaging findings.

PURPOSE: To determine magnetic resonance (MR) imaging features that characterize hepatic abscesses. MATERIALS AND METHODS: Clinical records and MR studies of 18 patients with proved hepatic abscesses were evaluated. The abscesses were pyogenic in 15 patients, fungal in two patients, and amebic in one patient. RESULTS: A total of 122 lesions were identified. Most were round (n = 114) with sharp borders (n = 99), hypointense on T1-weighted images (n = 73), and very hyperintense on T2-weighted images (n = 88). After injection of gadopentetate dimeglumine in 43 lesions, all 43 enhanced with sharp margins and 37 showed rim enhancement. All abscesses followed up diminished in size (50 of 50), and perilesional edema resolved before the central cavity did. CONCLUSION: MR imaging findings seen in hepatic abscesses include high signal intensity on T2-weighted images (72%) and perilesional edema (43 of 122 [35%]). Rim enhancement (86%) and increased conspicuity (35 of 43 [81%]) were found after injection of gadopentetate dimeglumine.

Adult↗
PubMedDate not supplied

Intracranial complications of sinusitis in children. A sequela of periapical abscess.

The cases of two children with periapical abscess in the upper incisors, sinusitis, and intracranial abscess are described. The ethmoid and maxillary sinuses were involved in both patients. Subdural empyema occurred in both, and one of the children had also cerebritis and brain abscess. Anaerobic bacteria were isolated from the infected subdural empyemas. Peptostreptococcus intermedius and microaerophilic streptococci were recovered in one patient and Fusobacterium sp in the other. Surgical drainage and appropriate antimicrobial therapy resulted in complete eradication of the infection in both patients. The role of anaerobic bacteria and the therapy directed against them in periapical abscess and the sinusitis and intracranial abscess which follow are discussed.

Brain Abscess↗
PubMed1990

Multiple cerebral and pulmonary arteriovenous malformations in association with brain and subcutaneous abscesses: a possible variant of hereditary hemorrhagic telangiectasia--case report.

The authors present a case in which multiple cerebral and pulmonary arteriovenous malformations (AVMs), a brain abscess, and a recurrent subcutaneous abscess were found concurrently in a 52-year-old male. He was admitted to our hospital for evaluation of a subcutaneous abscess in the right nuchal area and a right occipital AVM that had been detected at another hospital. Of his eight siblings, three had died of cerebrovascular disease (one in childhood and two as young adults), one had died of unknown causes in childhood, one had been hemiplegic since infancy, one had recently undergone removal of a pulmonary AVM, one was killed in World War II at the age of 24 years, and the remaining sibling was healthy. He had had surgery for a right occipital brain abscess three years prior to this admission. A general examination revealed no abnormalities other than the painful right nuchal mass. Neurological evaluation disclosed left homonymous hemianopsia, which was probably a result of his previous surgery for the right occipital brain abscess. Cerebral angiography showed AVMs in the right parietal (2 x 2 cm), right occipital (1.5 x 1.5 cm), and right cerebellar areas (1 x 1 cm). Digital subtraction angiography of the lung revealed multiple bilateral AVMs. The cerebral and pulmonary AVMs were removed in a two-stage operation. Although this case did not correspond precisely to the triad of hereditary hemorrhagic telangiectasia (HHT), the authors consider it to be related to HHT, since that syndrome is often complicated by multiple cerebral and pulmonary AVMs.

Abscess↗
PubMed1984

The variable CT appearance of hepatic abscesses.

Fifty computed tomographic (CT) scans in 33 patients with 37 separate episodes of hepatic abscess were reviewed retrospectively. Abnormalities were detected in all but one case (97% sensitivity). However, a characteristic CT appearance of hepatic abscess was not evident. Most intrahepatic foci were solitary, but multiple abscesses were present in 34% of cases. The CT appearance of the lesions varied from well defined, rounded cavities with contents near water density, resembling poorly defined hepatic cysts, to higher-density foci indistinguishable from hepatic neoplasms. In only 19% was gas present within the abscess. Rim enhancement was seen in only 6%. This study suggests that CT is a sensitive test for detecting hepatic abscess but is often nonspecific.

Adolescent↗
PubMed1991

Multiple brain abscess: a review of fourteen cases.

The case notes of 14 consecutive patients with multiple brain abscesses presenting over a 14 year period were studied with respect to the incidence and presentation, the source of infection, the investigations, microbiology and the treatment and outcome. The incidence of multiple brain abscesses in non-immunocompromised patients is 13% of all intracranial abscesses. Computerized tomographic scanning is vital both in the detection of multiple abscesses and in the subsequent assessment of therapy. The source of infection in half of our patients was the teeth or the paranasal sinuses. Streptococci were isolated in 63% of the patients; staphylococci in 21%. This has obvious implications for the antibiotic policy. Intracranial surgery, with few exceptions, had a diagnostic and management role rather than a curative one; identification of the causative organism was its prime purpose. CSF, obtained by lumbar punctures, did not provide any positive cultures and should not be contemplated in view of the inherent hazards. The elimination of the primary focus of infection was a most important step in the management of this condition. Multiple brain abscesses represent a potentially curable condition, provided appropriate antibiotics are used, the primary septic focus is eliminated and the intracranial complications are anticipated by the use of frequently repeated CT scans.

Adolescent↗
PubMedDate not supplied

[Meningioma with a peritumoral abscess].

The paper presents a rare case of meningioma associated with peritumoral abscess formed in a 63-year-old female undergone right nephrectomy for abscessed pyelonephritis and drainage of gluteal abscesses 3 months before admission. Brain computed tomography revealed a left frontotemporal heterogeneous mass lesion with margin contrast accumulation. At surgery, convexity meningioma with peritumoral abscess was totally removed. Hematogenous spread of Staphylococcus aureus is most likely to be responsible for peritumoral abscess. The paper also gives a review of literature and a brief account of the case.

Abscess↗
PubMed1992

[The surgical procedure and treatment of paravesical abscesses in acute cholecystitis in middle-aged and elderly patients].

The results of 238 operations performed for acute cholecystitis within 1985-1990 have been analysed. Of them in 11 (4.6%), paravesical (8 cases) and intrahepatic (3) abscesses were revealed. In 8 patients, the presence of an abscess at the preoperative period was supposed. All the patients were admitted to the hospital later than 24 h from the onset of the disease and operated on within 1 to 5 days. Perforation of the gallbladder was revealed in 5 patients, gangrene with destruction of its wall--in 3. Abscess location near the gallbladder fundus was noted in 4 patients, near its neck--in 2, along the medial surface--in 2. A unicameral abscess was revealed in 5 cases, a multicameral one--in 3. The operative treatment presents technical difficulties and consists in performance of cholecystectomy (sometimes--Pribram's mucoclasis), external drainage of the common bile duct and abscess cavity, drainage of the subhepatic and subphrenic space. One 82-year old patient died.

Abscess↗
PubMedDate not supplied

Subphrenic and pleural abscess due to spilled gallstones.

BACKGROUND: A 70-year-old male approximately 3 years after laparoscopic cholecystectomy presented to his primary care physician with a 4-month history of generalized malaise. METHODS: A workup included magnetic resonance imaging that revealed a perihepatic abscess. The patient underwent ultrasound-guided drainage, with the removal of 1400 mL of purulent fluid and placement of 2 drains. Computed tomographic scanning showed resolution, and he was discharged home on oral antibiotics. At 2-month follow-up, the patient was asymptomatic, denying any constitutional symptoms. However, abdominal computed tomographic scanning revealed recurrence of the abscess, which measured approximately 18 x 9 x 7.5 cm, with mass effect on the liver. The patient was placed on intravenous antibiotics and scheduled for operative drainage. The abdomen was entered with a right subcostal incision, and 900 mL of purulent fluid was drained. We also noted abscess erosion through the inferolateral aspect of the right diaphragm into the pleural space. The pleural abscess was loculated and isolated from the lung parenchyma. Palpation within the abscess cavity revealed 9 large gallstones. Following copious irrigation and debridement of necrotic tissue, 3 drains were placed and the incision was closed. RESULTS: The patient had an uneventful recovery and was discharged home on postoperative day number 6. Follow-up imaging at 3 months demonstrated resolution of the collection. CONCLUSION: Spillage of gallstones is a complication of laparoscopic cholecystectomy, occurring in 6% to 16% of all cases. Retained stones rarely result in a problem, but when complications arise, aggressive surgical intervention is usually necessary.

Abscess↗
PubMed1990

[Guided punctures in the treatment of hepatic and perihepatic abscesses under ultrasonic control].

The authors discuss the possibilities of ultrasonic tomography and subsequent performance of purposeful punctures for establishing the precise diagnosis of hepatic and perihepatic abscesses. In most cases the method helps in revealing the cavities measuring no more than 1.5-2.0 cm. The indications are determined, as well as the techniques of topical treatment with the use of single and multiple punctures and prolonged percutaneous drainage. Seventy-three patients (32 with hepatic and 41 with perihepatic abscesses) underwent clinical examination. Topical therapy was applied in 21 patients with discovered hepatic abscesses, 17 of them recovered. Operations were avoided in 25 in a group of 34 patients with perihepatic abscesses (in 7 the abscesses were not identified). The success of this treatment is determined by exact diagnosis and precise manipulations.

Adult↗
PubMed1984

Computed tomography of intraabdominal abscesses.

A total of 78 patients were subjected to computed tomography (CT) over a period of 18 months. CT proved extremely accurate in the diagnosis of intraabdominal abscesses and in estimating the extent of spread. The series included many examples of amoebic and hydatid abscesses with unusual presentations and appearances. The commonest appearance of abscesses on CT was a low-density mass with peripheral rims after the administration of intravenous contrast media, followed by gas-containing low-density lesions which were regarded as showing characteristic features of abscess formation. Pitfalls in the CT appearance of abdominal abscesses were many and correlation with the clinical presentation was essential for diagnosis. The greatest value of CT lay in the rapidity of diagnosis.

Abdominal Muscles↗
PubMed1980

Liver abscess at the Hadassah University during years 1967-77.

The charts of 36 patients, 27 males and 9 females, with liver abscess diagnosed at the Hadassah University Hospital between 1967-1977 were reviewed. The patients ranged in age from two months to 80 years and 25 patients (69%) were older than 40 years. The diagnosis was initially suggested by liver scan in 18 patients (50%), and was first made at autopsy in six (17%). The time-lapse between the onset of illness and diagnosis ranged from one day to 13 months, with a bimodal distribution. Large solitary abscesses were diagnosed later than small multiple abscesses. Ten patients (28%) were admitted with fever as the only sign of illness; specific signs and laboratory evidence of liver involvement often occurred late in the course of the disease. In 15 patients (42%), the etiology was regarded as amebic. In patients with pyogenic abscesses, the most commonly isolated organisms belonged to the normal bowel flora and biliary tract disease was present in 62% (13/21) of these patients. The overall mortality rate was 31%. This survey stresses the need for an increased awareness of the subtle presentation of liver abscess.

Adolescent↗
PubMed1994

[Clinical aspects, etiology, diagnosis and therapy of liver abscess. A retrospective study 1984-1991].

In a retrospective study (1984-1991) we evaluated 56 patients with pyogenic (44 patients) and with amebic (12 patients) liver abscesses. Patients with pyogenic liver abscesses usually belong to the older generation (70-80 years). Pyogenic abscesses are mainly due to a severe underlying disease and patients are in poor general condition. Therapy includes antibiotics and in most cases drainage (nowadays mainly percutaneous; surgical drainage should only be used with a simultaneous intraabdominal procedure for treatment of the underlying disease). The mean hospitalization time is 33 days. Prognosis is good, the mortality of 14% being mainly due to severe underlying disease. This latter can be found in 75% of the patients and should be treated electively. In amebic liver abscesses the patients are much younger (around 30 years). Patients are in good general condition and antibiotics alone are sufficient for radical treatment. The mean hospitalization time is 16.5 days and mortality is zero. Symptoms and clinical signs are the same in both groups: fever, right upper quadrant tenderness, jaundice and hepatomegaly. Diagnosis by ultrasonography and/or computed tomography is very reliable. History and serology are reliable for differentiation of the two types. With a correct diagnostic approach and treatment, liver abscesses are today benign conditions with a low mortality.

Adult↗
PubMed1997

Vitrectomy for endogenous Klebsiella pneumoniae endophthalmitis with massive subretinal abscess.

A 39-year-old man with pyogenic liver abscess had bilateral endogenous Klebsiella pneumoniae endophthalmitis. At presentation, the left eye had a localized subretinal abscess. Despite repeated intravitreal amikacin and dexamethasone injections, a subretinal abscess spread and detached all of the retina. Pars plana vitrectomy with drainage of the subretinal abscess was performed. The retina was reattached, and the patient had 5/200 vision 5 months postoperatively. Early vitrectomy with drainage of the subretinal abscess may save some eyes with endogenous Klebsiella pneumoniae endophthalmitis.

Abscess↗
PubMed2003

Cosmetic considerations in surgery for orbital subperiosteal abscess in children: experience with a combined transcaruncular and transnasal endoscopic approach.

OBJECTIVE: To evaluate the outcomes of a new surgical approach in children with acute sinusitis and medial orbital subperiosteal abscess. DESIGN: Case series. SETTING: Tertiary pediatric hospital. PATIENTS: Eleven children aged 6 weeks to 13 years with orbital subperiosteal abscess and acute sinusitis who met indication for surgery by visual compromise and/or refractory course to medical therapy. INTERVENTION: The medial orbital abscess was drained via a transcaruncular approach, which provided access to the medial orbital wall. An endoscopic ethmoidectomy was also performed. MAIN OUTCOME MEASURES: Judgment of cosmetic appearance by surgeon and family, resolution of symptoms, length of hospital stay, and complications. RESULTS: All children had prompt resolution of symptoms after surgical drainage. Cosmetic outcome was excellent in all patients with no cutaneous scar or eyelid malposition. After edema and cellulitis had resolved, no family member could tell a difference in appearance between the eyes. No complications of these combined procedures were identified. One patient who had initially undergone transnasal endoscopic orbital drainage alone experienced a recurrence of infection 17 days later. He was then treated by the combined transcaruncular and endoscopic approach with prompt resolution of his symptoms. One of 4 patients treated initially with transcaruncular approach alone without endoscopic ethmoidectomy had recurrence of acute sinusitis and orbital abscess 16 months later and was successfully treated with an endoscopic approach. CONCLUSIONS: The combined endoscopic and transcaruncular surgical approach to medial orbital subperiosteal abscess and acute sinusitis provides a cosmetically superior outcome compared with standard orbital approaches requiring a cutaneous incision. The transcaruncular approach can be considered as an alternative or adjunct approach to the medial orbit, with the same cosmetic advantages as transnasal endoscopic drainage.

Abscess↗