Intradiaphragmatic abscess. An extremely rare complication of pneumatic dilatation of the esophagus.

A patient with dysphagia initially diagnosed as achalasia but now thought to have spinocerebellar degeneration manifesting itself in the esophagus as achalasia, developed an intradiaphragmatic abscess, presumably as a complication of pneumatic dilation of the esophagus. This previously unreported complication occurred as a result of transmural spread of bacteria at the time of dilatation with seeding of the diaphragmatic muscle. An intradiaphragmatic abscess may be mistakenly diagnosed clinically and radiologically as a subphrenic abscess or loculated empyema. Management of intradiaphragmatic abscess is discussed briefly.