When is pneumonia not pneumonia?

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
JournalBMJ Case Reports
Publication statusPublished - 8 Jun 2015


  • Abdominal Pain
  • Adult
  • Appendectomy
  • Appendicitis
  • Cough
  • Diagnostic Errors
  • Drainage
  • Humans
  • Laparotomy
  • Male
  • Pneumonia
  • Subphrenic Abscess
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Case Reports
  • Journal Article


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