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                                    [Emergency Care Journal 2015; 11:5068]                                                      [page 19]

Usefulness of dynamic 
compression bedside 
ultrasonography 
in the diagnosis of abdominal
wall abscess
Bahjat Barakat,1 Raffaele Pezzilli2
1Department of Emergency, S. Orsola-
Malpighi University Hospital, Bologna;
2Department of Digestive System, 
S. Orsola-Malpighi University Hospital,
Bologna, Italy

A 55 year-old male patient positive for HIV
and chronic virus C hepatitis, medically treat-
ed for a previous left inguinal hernioplasty was
admitted to emergency room because of 4-day
long persistent non-specific pain of the left
abdominal lower part. On admission at the
emergency room, at physical examination
there was pain on palpation midway between
umbilicus and right inferior quadrant without
rebound tenderness in the whole abdomen
without erythema or skin warm. The rectal
temperature was normal as well as cardiac and
lung physical examination. Laboratory exami-
nation revealed an increase of white blood
cells (11.63 103/mmc, reference values 4.20-
9.00) with 80% of neutrophils and C-reactive
protein 6.17 mg/dL (upper reference limit
0.80). Renal, hepatic and coagulation parame-
ters were within the normal limits. X-ray of the
abdomen did not show alterations. A bedside
dynamic compression ultrasound (US) showed
a hypo-anechogenic area measuring 8.4 cm
and 4.4 cm having fluctuating internal echoes,

irregular margins of the left rectus abdominis
muscle and swollen lymph nodes (Figure 1). To
better define the US picture, a computed
tomography (CT) scan was carried out, con-
firming the US picture (Figure 2). The abscess
was surgically drained and the culture of the
abscess revealed a Staphylococcus areus infec-
tion. The patient was discharged after 2 days
with antibiotic therapy.

From an epidemiological point of view, the
frequency of the abscess of soft tissue is
increased in Western countries especially in
HIV infected patients1 and the bacterium usu-
ally isolated is the Staphylococcus areus.2 The
pathogenesis of this entity is unknown and
probably HIV-infected patients are commonly
colonized by Staphylococcus aureus.
Neutrophils of these patients frequently have
phagocytic, chemotactic, and oxidative defects
and impaired bactericidal activity against
Staphylococcus aureus.2 The diagnosis should
be based on clinical signs such as pain.
Dynamic compression ultrasound is usually
the technique to easily detect the pyomyosi-
tis,3-6 while CT scan generally does not add any
further useful information. The treatment is
surgical and the follow-up is uneventful. 

References

1. Al-Tawfiq JA, Sarosi GA, Cushing HE.
Pyomyositis in the acquired immunodefi-
ciency syndrome. South Med J
2000;93:330-4.

2. Schwartzman WA, Lambertus MW,
Kennedy CA, Goetz MB. Staphylococcal
pyomyositis in patients infected by the
human immunodeficiency virus. Am J Med

1991;90:595-600.
3. Loyer EM, Kaur H, David CL, et al.

Importance of dynamic assessment of the
soft tissues in the sonographic diagnosis
of echogenic superficial abscesses. J
Ultras Med 1995;14:669-71. 

4. Chau CL, Griffith JF. Musculoskeletal
infections: ultrasound appearances. Clin
Radiol 2005;60:149-59. 

5. Kinare A, Brahmnalkar M, D'Costa S.
Ultrasound of musculoskeletal soft tissue
masses. Ind J Radiol Imag 2007;17:201-8.

6. Tichter A, Riley DC. Emergency depart-
ment diagnosis of a quadriceps intramus-
cular loculated abscess/pyomyositis using
dynamic compression bedside ultrasonog-
raphy. Crit Ultrasound J 2013;5:3. 

                                                        Emergency Care Journal 2015; volume 11:5068

Correspondence: Raffaele Pezzilli, Department of
Digestive System, Sant’Orsola-Malpighi Hospital,
via Massarenti 9, 40138 Bologna, Italy.
Tel: +39.051.6364148 - Fax: +39.051.6364148.
E-mail: raffaele.pezzilli@aosp.bo.it

Key words: Abscess abdominal wall;
Ultrasonography; Computed tomography; High
risk population.

Received for publication: 25 January 2015.
Accepted for publication: 2 February 2015.

This work is licensed under a Creative Commons
Attribution 3.0 License (by-nc 3.0).

©Copyright B. Barakat and R. Pezzilli, 2015
Licensee PAGEPress, Italy
Emergency Care Journal 2015; 11:5068
doi:10.4081/ecj.2015.5068

Figure 1. Bedside dynamic compression ultrasound showing a
hypo-anechogenic area with fluctuating internal echoes, irregu-
lar margins of the left rectus abdominis muscle. The red arrows
indicate the abscess.

Figure 2. Contrast-enhanced computed tomography scan show-
ing inhomogeneous soft tissue mass of the left rectus abdominis
muscle, containing low and high-density structures. The abscess
is indicated by a red circular line.

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