Acute appendicitis with perforation presenting as subphrenic abscess

Background. - Idiopathic subphrenic abscesses are uncommon in children. Sta ndard chest X-rays may provide the suspicion of this diagnosis. Initial per cutaneous drainage of the collection is usually performed. Surgery is requi red when the underlying cause remains unknown. Case report. - A 12-year-old boy presented signs of pulmonary abscess. Ches t X-rays, ultrasonography and completed tomography established the diagnosi s of a right subphrenic abscess, which was percutaneously drained. Surgery disclosed an ectopic appendiceal perforation. Conclusion. - In children, appendicitis is the main etiology of primary or postoperative subphrenic suppurations. Ectopic appendicitis is an important predisposing factor to this complication. (C) 1999 Elsevier, Paris.