In the absence of air, it is not possible to deduce whether a fluid collection in infected or not. If there is a strong clinical suspicion of infection, and if there is no air or air-fluid level, then a CT or USG-guided aspiration of one or more of the collections is suggested, for this purpose.
In this patient, there are multiple acute fluid collections (Figs. 1, 2). Infection was suspected and though frank pus was not aspirated (Fig. 3), the aspirate grew gram negative bacteria and the patient was put on appropriate antibiotics and improved.
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