Images and Reflections

Elsewhere in this issue of The Journal (p 2728) is an excellent assessment of the role of ultrasonography, computed tomographic (CT) scanning, and radionuclide scintigraphy in the detection and drainage of abdominal abscesses. The accuracy of abscess detection and treatment by ultrasonography and CT scan await confirmation as use of these techniques is extended to smaller centers throughout the country. Ferrucci and vanSonnenberg report false-negative and false-positive results. Instances of misdiagnosis of lateral chest wall abscesses above or below the diaphragm, as well as misinterpretation of bowel air for abscess, have already been encountered. Emphasis on the need for careful clinical correlation of history and physical findings is reiterated. Ultrasophisticated diagnostic methods will not influence unduly a clinical decision among those whose experience and basic skills are well developed.

Percutaneous drainage, the therapeutic extension of imaging diagnosis, whether by needle aspiration or by guided-wire— catheter drainage, has some attractive features.