PMC5437986_01
Axial, noncontrasted CT image at the level of the porta hepatis demonstrates freely mobile peritoneal fluid tracking along the liver, spleen, and left lateral abdominal wall at the initial diagnosis of pseudomonas peritonitis.
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Figure1
A CT scan of the abdomen (Figure 1) demonstrated freely communicating intra-abdominal fluid and initial fluid samples grew Pseudomonas aeruginosa.
A: Axial CT noncontrasted image at the level of the porta hepatis obtained 18 weeks after index admission. There has been interval development of a loculated, thick walled fluid collection anterior to the liver. The perisplenic and perigastric fluid is no longer present. B: Coronal reconstructed image through the anterior abdomen at 18 weeks demonstrates the craniocaudal extent of the encapsulated fluid collection which extends from the right subphrenic space into the pelvis. Although the collection closely approximates and exerts a mass effect on adjacent small bowel, there is no invasion or trapping of bowel.
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Figure2
After 15 weeks, he had another episode of abdominal pain (Table 1) and at that time (Figure 2), CT scan of the abdomen demonstrated compartmentalization of abdominal fluid with the development of a thick wall or "rind" encapsulating a large right abdominal fluid collection.
Axial, noncontrasted CT image slightly superior to the porta hepatis obtained at 8 months. The image demonstrates a persistent, encapsulated anterior perihepatic fluid collection (Culture negative). Although the collection has decreased in size from the previous exam, the "rind" is unchanged.
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Figure3
Three months later, a CT scan was performed and revealed persistence of a large peri-hepatic fluid collection enclosed within the same thick wall (Figure 3).
Axial noncontrasted image at the level of the porta hepatis obtained at 9.5 months. It demonstrates free-flowing, homogenous fluid tracking along liver, spleen, and left lateral abdominal wall. The "rind" has resolved.
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Figure4
A final CT examination of the abdomen 6 weeks later (Figure 4) showed continued diminution of the fluid collection, which again was sterile.