Draining of subphrenic abscess into pericardial cavity - an incidental finding

The direct extension of a subphrenic abscess into the pericardial cavity is a rare finding. We report a 13 year old boy with Past History of Abdominal surgeries presenting with Right Upper quadrant pain, fever, chest pain and shortness of breath. An abdominal USG diagnosed a subphrenic abscess and an EGG demonstrated diffuse ST and T wave changes depictive of Acute Pericarditis. Echo guided drainage of thick pus from the pericardial cavity was performed which followed USG guided drainage of subphrenic abscess and finally Exploratory Laparotomy and drainage of subphrenic abscess + Mediastonotmy and Pericardiostomy + diaphragmatic repair was performed