CONFIRMING DIAGNOSIS ¾>" (2 cm) in diameter, together with characteristic clinical features, confirms the diagnosis. A computed tomography scan also confirms the diagnosis.
A liver ultrasound may indicate defects caused by the abscess, but it’s less definitive than a liver scan. Relevant laboratory values include elevated serum aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and bilirubin levels; increased white blood cell count; and decreased serum albumin levels. In pyogenic abscess, a blood culture can identify the bacterial agent; in amebic abscess, a stool culture and serologic and hemagglutination tests can assist in diagnosis.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Anorectal abscess and fistula:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
Anorectal abscess is detectable on physical examination. If the abscess drains by forming a fistula, the pain usually subsides and the major signs become pruritic drainage and subsequent perianal irritation. The external opening of a fistula generally appears as a pink or red, elevated, discharging sinus or ulcer on the skin near the anus. Depending on the infection’s severity, the patient may have chills, fever, nausea, vomiting, and malaise. Digital examination may reveal a palpable indurated tract and a drop or two of pus on palpation. The internal opening may be palpated as a depression or ulcer in the midline anteriorly or at the dentate line posteriorly. Examination with a probe may require an anesthetic. A proctosigmoidoscopy may be performed to exclude associated diseases.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Throat abscesses:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
Diagnosis of peritonsillar abscess usually begins with a patient history of bacterial pharyngitis. Examination of the throat shows swelling of the soft palate on the abscessed side, with displacement of the uvula to the opposite side; red, edematous mucous membranes; and tonsil displacement toward the midline. Culture may reveal streptococcal or staphylococcal infection.
Diagnosis of retropharyngeal abscess is based on patient history of nasopharyngitis or pharyngitis and on physical examination revealing a soft, red bulging of the posterior pharyngeal wall. X-rays show the larynx pushed forward and a widened space between the posterior pharyngeal wall and vertebrae. If neck pain or stiffness occurs, look for extension to the epidural space or the cervical vertebrae. Culture and sensitivity tests isolate the causative organism and reveal the appropriate antibiotic.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Perirectal abscess and fistula:
Diagnosis
(Handbook of Diseases)
Perirectal abscess is detectable on physical examination:
❑ Perianal abscess is a red, tender, localized, oval swelling close to the anus. Sitting or coughing increases pain, and pus may drain from the abscess. Digital examination reveals no abnormalities.
❑ Ischiorectal abscess involves the entire perianal region on the affected side of the anus. The only symptom of this large erythematous, indurated, tender mass may be pain. It’s tender but may not produce drainage. Digital rectal examination reveals a tender induration bulging into the anal canal.
CLINICAL TIP: A flexible sigmoidoscopy should be performed later on these patients to rule out cancer or inflammatory bowel disease.
❑ Submucous or high intermuscular abscess may produce a dull, aching pain in the rectum, tenderness and, occasionally, induration. Digital examination reveals a smooth swelling of the upper part of the anal canal or lower rectum.
❑ Pelvirectal abscess (rare) produces fever, malaise, and myalgia but no local anal or external rectal signs or pain. Digital examination reveals a tender mass high in the pelvis, perhaps extending into one of the ischiorectal fossae.
If the abscess drains by forming a fistula, the pain usually subsides and the major signs become pruritic drainage and subsequent perianal irritation.
CLINICAL TIP: Pain and discharge are symptoms of fistula development and the closure of the external or secondary opening.
The external opening of a fistula generally appears as a pink or red, elevated, discharging sinus or ulcer on the skin near the anus. Depending on the infection’s severity, the patient may have chills, fever, nausea, vomiting, and malaise. Digital rectal examination may reveal a palpable indurated tract and a drop or two of pus on palpation. The internal opening may be palpated as a depression or ulcer in the midline anteriorly or at the dentate line posteriorly. To identify an internal opening, an examination under anesthesia should be performed.
Flexible sigmoidoscopy, barium studies, and colonoscopy should be performed to rule out underlying conditions.
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Source: Handbook of Diseases, 2003
Brain abscess:
Diagnosis
(Handbook of Diseases)
A history of infection — especially of the middle ear, mastoid, nasal sinuses, heart, or lungs — or a history of congenital heart disease, along with a physical examination showing such characteristic indications as increased intracranial pressure (ICP), points to a brain abscess. An enhanced computed tomography (CT) scan and, occasionally, arteriography (which highlights the abscess by a halo) help locate the site.
Examination of cerebrospinal fluid can help confirm infection, but lumbar puncture is too risky because it can release the increased ICP and provoke cerebral herniation. A CT-guided stereotactic biopsy may be performed to drain and culture the abscess. Other tests include culture and sensitivity of drainage to identify the causative organism, skull X-rays, and a radioisotope scan.
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Source: Handbook of Diseases, 2003
Lung abscess:
Diagnosis
(Handbook of Diseases)
The following tests are used to diagnose a lung abscess:
❑ Auscultation of the chest may reveal crackles and decreased breath sounds.
❑ Chest X-ray shows a localized infiltrate with one or more clear spaces, usually containing air-fluid levels.
❑ Chest computed tomography scan confirms the presence of localized infiltrate or nodular density, occasionally with air-fluid level. Chest imaging may also identify airway masses or foreign bodies that have led to abscess formation.
❑ Percutaneous aspiration of an abscess or bronchoscopy may be used to obtain cultures to identify the causative organism. Bronchoscopy is only used if abscess resolution is eventful and the patient’s condition permits it.
❑ Blood cultures, Gram stain, and sputum culture are also used to detect the causative organism.
❑ White blood cell count commonly exceeds 10,000/µl.
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Source: Handbook of Diseases, 2003
Liver abscess:
Diagnosis
(Handbook of Diseases)
Ultrasonography and computed tomography (CT) scan with contrast medium can accurately define intrahepatic lesions and allow assessment of intra-abdominal pathology. Percutaneous needle aspiration of the abscess can also be performed with diagnostic tests to identify the causative organism. Contrast-aided magnetic resonance imaging may also become an accurate method for diagnosing hepatic abscesses.
Abnormal laboratory values include elevated levels of serum aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and bilirubin; an increased white blood cell count; and decreased serum albumin levels. With pyogenic abscess, a blood culture can identify the bacterial agent; with amebic abscess, a stool culture and serologic and hemagglutination tests can isolate E. histolytica.
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Source: Handbook of Diseases, 2003
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