title: When is pneumonia not pneumonia?
abstract: A 34-year-old man was admitted to hospital via the accident and emergency department with severe right-sided abdominal pain and raised inflammatory markers. His pain settled with analgaesia and he was discharged with a course of oral co-amoxiclav. He was readmitted to the hospital 7 days later reporting cough and shortness of breath. His chest X-ray showed a raised right hemi-diaphragm, presumed consolidation and a right-sided effusion. As a result, he was treated for pneumonia. Despite antibiotic therapy his C reactive protein remained elevated, prompting an attempt at ultrasound-guided drainage of his effusion. Finding only a small amount of fluid, a CT of the chest was performed, and this showed a subphrenic abscess and free air under the diaphragm. A CT of the abdomen was then carried out, showing a perforated appendix. An emergency laparotomy was performed, the patient's appendix was removed and the abscess drained.
authors.affiliation: Northampton General Hospital, Northampton, UK.
authors.forename: Ayodele
authors.initials: A
authors.lastname: Sasegbon
mesh_terms: D015746:Abdominal Pain / Q000209:etiology*; D000328:Adult; D001062:Appendectomy / Q000379:methods; D001064:Appendicitis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D003371:Cough / Q000209:etiology*; D003951:Diagnostic Errors; D004322:Drainage / Q000379:methods; D006801:Humans; D007813:Laparotomy; D008297:Male; D011014:Pneumonia / Q000175:diagnosis*; D013369:Subphrenic Abscess / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome