The effect of drainage tube size on adequacy of percutaneous abscess drainage

Fifty-one patients with documented abdominal abscess cavities were treated by percutaneous abscess and fluid drainage (PAFD). Drainage catheters made of various materials in sizes ranging from 5 through 18 French (Fr) were retrospectively studied and prospectively assigned to patients. No significant difference in the success or failure of PAFD as a function of these factors was found once an 8.3 Fr catheter with 0.045-inch diameter sideholes was reached; catheters larger than this were not associated with improved patient outcome. Failues of PAFD occurred primarily with the presence of phlegmonouscollections and cavities with fistulous connection to bowel. This study was presented as a Scientific Paper (#177) at the 69th Scientific Assembly and Annual Meeting of the Radiologic Society of North America in Chicago, Illinois, November 14, 1983.     

Percutaneous biopsy and drainage procedures in the abdomen using a modified coaxial technique

A modified coaxial technique for biopsy and drainage procedures in the abdomen is described. This technique involves initial placement of a 23-gauge needle into an abdominal organ or mass. Once proper position is obtained, the hub of the needle is removed and a 19-gauge or larger needle is placed over the 23-gauge needle. Through this larger needle, either multiple biopsies are performed or guidewire exchange for a larger catheter is accomplished. The technique was used in performance of seven biopsy procedures, one biliary drainage procedure, and three nephrostomies.     

超声引导经皮穿刺治疗乳腺脓肿的临床应用

目的评价超声引导下经皮穿刺治疗乳腺脓肿的临床应用价值。方法在超声引导下,对诊断为乳腺脓肿的病人采用经皮穿刺脓肿抽吸法及脓腔置管引流法进行治疗。结果 45例病人共有54个脓肿,22个最大径≤3 cm的脓肿采用脓肿抽吸法治愈21例,1例改行脓腔置管引流后治愈;32个最大径>3 cm的脓肿实施脓腔置管引流法,治愈30例,切开引流2例。随访41例,复发4例,2例再次行脓腔置管引流治愈,另2例行脓肿切开引流治愈。结论超声引导下穿刺抽吸治疗不超过3 cm的乳腺脓肿与置管引流治疗超过3 cm的乳腺脓肿均是有效的治疗手段。     

A simple method to lock large mushroom-tip catheters.

Dislodgment is a major drawback with large-bore Malecot catheters. A locking mechanism with a suture affixed to the distal portion of the mushroom tip is described. In a 32-month period, 17 Malecot catheters with locking mechanisms were placed in 15 patients. One catheter dislodged as a result of suture failure. A variation in design prevented subsequent failure of sutures. This simple locking mechanism prevents collapse of the catheter wings and thereby maintains catheter placement.     

Interventional ultrasound in the musculoskeletal system

This article highlights the multiple applications of ultrasound as a guidance modality for interventional procedures in the musculoskeletal system. The percutaneous aspiration, drainage, and biopsy of musculoskeletal abscesses, masses, and focal muscular pathology in the extremities, trunk, and neck using ultrasound as the guidance system is described. Techniques for biopsy, fluid aspiration, catheter insertion, and needle visualization by ultrasound are discussed.     

US-guided transvaginal drainage of pelvic abscesses and fluid collections

Ultrasound (US)-guided transvaginal needle or catheter drainage was performed in 14 women for a variety of pelvic abscesses and fluid collections; tubo-ovarian abscesses and postoperative collections were most common. Diagnosis was achieved in all 14 patients (100%), including one patient with suspected ovarian carcinoma who underwent only diagnostic needle aspiration and no therapeutic drainage. Abscesses or fluid collections were evacuated in 13 of 13 patients (100%) with either needle (n = 7) or catheter (n = 6) drainage (with appropriate antibiotics). Twelve of the 14 patients (86%) were spared an operation; surgery was undertaken in two patients for a persistent tubo-ovarian phlegmon. No major complications were associated with drainage. Catheters were removed an average of 6.7 days after insertion. The success, safety, and advantages of US-guided transvaginal drainage in our early experience suggest its use as an alternative to standard percutaneous catheter procedures to diagnose and drain certain pelvic abscesses and fluid collections.     

Percutaneous treatment of large pyogenic liver abscess

Surgical drainage has been the traditional mode of treatment of pyogenic liver abscess but this was replaced by IV broad-spectrum antibiotics and imaging-guided percutaneous drainage either via needle aspiration or percutaneous catheter drainage (CD). There is a debate about which is better intermittent needle aspiration or CD.     

CT-guided transgluteal drainage of deep pelvic abscesses: indications, technique, procedure-related complications, and clinical outcome.

Deep pelvic abscesses may present a unique challenge for percutaneous drainage because of numerous overlying structures, which preclude safe percutaneous access. These structures include the pelvic bones, intestine, bladder, iliac vessels, and gynecologic organs. Use of the transgluteal approach to drain these abscesses can circumvent these obstacles and provide a useful surgical alternative or a temporizing measure. The transgluteal approach requires a thorough understanding of the anatomy of the sciatic foramen region and associated anatomic structures. The ideal approach for transgluteal access is to insert the catheter as close to the sacrum as possible, at the level of the sacrospinous ligament. Transgluteal drainage can be performed with the tandem-trocar technique or the Seldinger technique. Modifications of the procedure are needle aspiration not followed by catheter placement, use of the angled gantry technique, bilateral transgluteal drainage, combined anterior and posterior drainage, and drainage of necrotic pelvic masses. The transgluteal approach is a useful option in pediatric patients. Daily catheter care is essential for successful percutaneous catheter therapy. Although pain has been cited as a common complication of the technique, this complication can be minimized with judicious use of analgesia and a meticulous technique. Other complications are hemorrhage and catheter malposition.     

Ultrasound guidance for pericardiocentesis

Sonographic guidance with 41 punctures and 38 catheterizations was employed in 68 patients. The approach was either intercostal or subxiphoid. Most punctures were performed with a 1.4-mm-thick plastic-sheathed cannula after local anesthesia. Complications were observed in 7 patients. In one patient a catheter introduced with a movable core-type guidewire pierced the right ventricle wall with uneventful recovery after surgery. Intercostal drainage caused pleural pain in 2 patients, and in 2, leakage to the pleural space. Two patients with heart transplants had severe bradycardia and drop of blood pressure, one after needle drainage and the other during guidewire manipulation. Direct monitoring generally ensures a correct position of the instruments and hazards to adjacent organs can be avoided. In small effusions a simple needle aspiration with a plastic-sheathed cannula is safer than catheter drainage.     

Feasibility of MR imaging-guided percutaneous drainage of pancreatic fluid collections

PURPOSE: To assess the feasibility and safety of magnetic resonance (MR) imaging-guided percutaneous drainage of pancreatic fluid collections in an open configuration low field MR imaging system. MATERIALS AND METHODS: Ten patients with pancreatic fluid collections were examined prospectively. Five of the fluid collections were symptomatic pseudocysts and five were pancreatic abscesses. All percutaneous drainages were performed solely under MR imaging guidance with a 0.23-T open configuration C-arm shaped MR imaging scanner with interventional optical tracking. Every step of the procedure was monitored using balanced fast field echo sequences. In each case, the drainage of the fluid collection was performed with a MR imaging-compatible drainage kit using the Seldinger technique. The kit included an 18-gauge needle, a 0.035-inch stiff guide wire, 6-F and 8-F dilators, and an 8-F pigtail drainage catheter. RESULTS: All drainage catheters could successfully be placed into the pancreatic fluid collections under MR imaging guidance. Visualization of the needle, dilator, and drainage catheter was excellent. However, visualization of the guide wire was suboptimal. The mean time needed for the MR-guided drainage procedure was 44 minutes. No immediate complications occurred. The clinical success rate of the percutaneous drainage was 70%; three patients were subsequently treated surgically. There were no deaths. The average duration of catheterization was 40 days. CONCLUSION: MR imaging-guided percutaneous drainage of pancreatic fluid collections is feasible and safe. The presented technique has limitations--lack of real-time imaging control and small selection of MR imaging-compatible devices--that necessitate further technical developments before the procedure can be recommended for routine clinical use.     

Percutaneous drainage of postoperative abdominal and pelvic lymphoceles

Eleven patients with postoperative abdominal and pelvic lymphoceles underwent percutaneous diagnostic and therapeutic intervention with either needle aspiration or catheter drainage. Although initial sonographic or CT examinations accurately identified these collections, definitive diagnosis required fluid sampling and laboratory analysis for confirmation. Seven pelvic and two retroperitoneal lymphoceles demonstrated a gross appearance and composition different from two lymphatic collections in the upper peritoneum. Nine patients underwent catheter drainage; two were managed by needle aspiration alone. Duration of catheter drainage was 4-120 days, substantially longer than is customary for standard fluid collections. Nine of 11 patients were cured by percutaneous aspiration or drainage alone. Bacterial colonization developed in three persistently draining lymphoceles. However, no clinical sepsis or bacteremia occurred. In another patient with persistent high-volume lymphatic output, sclerotherapy with tetracycline instillation was successful in rapidly closing the lymphatic fistula. Percutaneous drainage is a safe, effective procedure for drainage of postoperative lymphoceles.     

New fine needle for cholangiography with optional sheath for decompression.

A 45-cm Chiba needle with a 20-cm sheath at the hub end has been used successfully for percutaneous transhepatic cholangiography in 10 patients, including chronic decompression in one patient. This method permits localization of the biliary tree, vascular structures, cysts, cavities, pelvocalyceal system, and tumors with a 22 gauge needle and allows placement of a larger catheter for drainage or a larger needle for biopsy if required. No complications were observed.     

Breast abscess in lactating women: US-guided treatment

PURPOSE: To retrospectively evaluate the use of ultrasonography (US)-guided treatment of breast abscesses in lactating women. MATERIALS AND METHODS: One hundred eight consecutive lactating women who were clinically suspected of having a breast abscess were examined with US. Abscesses depicted at US were treated with US guidance, and the success of US-guided treatment was retrospectively determined. RESULTS: Fifty-six abscesses were identified at US in 43 women; all abscesses were treated with US guidance: 23 with needle aspiration and 33 with catheter drainage. Treatment method was determined according to the size of the abscess. Abscesses that were smaller than 3 cm in maximum diameter were treated with needle aspiration, and abscesses that were 3 cm or larger in maximum diameter were treated with catheter insertion. One patient who was treated with needle aspiration subsequently underwent surgical intervention; all others were successfully treated with US intervention. Catheter placement was well tolerated (mean pain score 2.3 in 22 women by using a subjective pain scale of 0-10). CONCLUSION: US-guided needle aspiration of abscesses smaller than 3 cm and US-guided catheter drainage of abscesses 3 cm or larger are successful means of treating breast abscesses.     

Transcatheter biopsy of lesions obstructing the bile ducts

A method was developed for biopsy sampling of masses obstructing the biliary system in patients with a biliary drainage catheter. The biopsy needle is inserted through the drainage catheter, with fluoroscopic guidance, to the site of the lesion. The technique has been used without complication in more than 30 patients with cancer of the pancreas and bile ducts.     

Percutaneous drainage of abdominal fluid collections in children

Percutaneous drainage of intraabdominal fluid collections was performed in 13 children. After initial diagnosis with either sonography or computed tomography, a smallbore aspiration needle (22 gauge) was guided into the collection, usually by sonography. In five patients, complete evacuation was possible using the aspirating needle alone. In seven others, the fluid was successfully drained via a catheter introduced percutaneously. In one patient, surgery was required for complete evacuation of a hematoma containing large blood clots. There were no complications.     

US-guided needle aspiration and catheter drainage as an alternative to open surgical drainage for uniloculated neck abscesses

PURPOSE: To prospectively evaluate the effectiveness of ultrasound (US)-guided needle aspiration and catheter drainage as an alternative to open surgical drainage of uniloculated neck abscesses. MATERIALS AND METHODS: Fifteen consecutive patients (11 female, four male; age range from 18 days to 78 years, mean 42.5 y +/- 22.4) diagnosed with deep neck infections associated with uniloculated neck abscesses were treated. The patients were originally scheduled for surgical incision and drainage after a period of unsuccessful treatment with antibiotics. US-guided needle aspiration (in 10 patients) and US-guided catheter drainage (in five patients) were performed under local anesthesia. Open surgical drainage was performed when US-guided drainage procedures failed. RESULTS: Surgical open drainage was avoided in 13 of the 15 patients (87%). An average of 6 mL of pus was obtained in patients in the needle aspiration group and 140 mL of pus was drained by catheter. One patient had a recurrent pyogenic lymphadenitis at the same location and was treated successfully by repeated needle aspiration. No complications occurred in this study. CONCLUSION: In a selected group of patients without imminent airway obstruction, most uniloculated neck abscesses may be managed initially by US-guided needle aspiration and catheter drainage before resorting to open surgical drainage.     

超声介入治疗细菌性肝脓肿的两种方法疗效比较

 目的 对比研究超声引导下经皮肝穿刺细针抽吸术与置管引流术治疗细菌性肝脓肿的疗效。方法 细菌性肝脓肿98例,其中直径≥5 cm 46例,直径＜5 cm 52例。对以上两种大小的脓肿,分别采取超声引导下经皮肝穿刺细针抽吸术和置管引流术两种方法治疗,比较两种方法治疗后脓肿消失时间、患者住院时间、血象、体温恢复正常时间等。结果 直径≥5 cm肝脓肿,置管引流术组在住院天数、脓腔消失时间等方面优于细针抽吸术组（P＜0.05）,在术后血象、体温恢复正常时间方面两种方法无统计学差异（P>0.05）。直径＜5 cm肝脓肿,两种方法在住院天数、脓腔消失时间、术后血象、体温恢复正常时间方面无统计学差异（P>0.05）。结论 对于直径≥5 cm、直径＜5 cm的细菌性肝脓肿,应分别首选超声引导下经皮肝穿刺置管引流术、细针抽吸术。     

CT-Guided Placement of a Drainage Catheter Within a Pelvic Abscess Using a Transsacral Approach

A 66-year-old man underwent CT-guided drainage catheter placement within a pelvic abscess with a diameter of 46 mm. We performed the drainage by a transsacral approach because it was considered the safest and most feasible approach. An 8G bone marrow biopsy needle was used to penetrate the sacrum to create a path for subsequent drainage catheter insertion. After withdrawal of the biopsy needle, a 6 Fr catheter was advanced into the abscess cavity through the path using the Seldinger technique. Except for bearable pain, no procedure-related complications occurred. Twenty-nine days after the placement, the catheter was withdrawn safely and the abscess cavity had shrunk remarkably.     

Serious complications following transgression of the pleural space in drainage procedures

Transgression of the parietal pleura may occur during placement of interventional drainage catheters into the liver and upper abdomen, and occasionally results in lethal complications. In a review of nearly 2,000 such procedures, four deaths were found to be related directly to pleural transgression from biliary drainage. Therefore, the anatomy of the pleura pertinent to abdominal needle or catheter insertion was analyzed. In 14 cadavers examined after intercostal needle insertion into the liver, needles inserted through the 9th intercostal space or higher punctured the pleura in all but one cadaver. Radiologic studies of 15 clinical cases revealed that elderly patients rarely depressed the diaphragm below the 9th intercostal space, which increases the risk of unsuspected puncture of the pleura. Review of clinical material revealed that diagnostic needle puncture through the parietal pleura carries far less risk than placement of a long-term drainage catheter. Methods to avoid puncture of the pleura, as well as the technical problems involved in such maneuvers, are given.     

Percutaneous catheter drainage of abdominal abscesses guided by ultrasound and computed tomography.

Ultrasonography and computed tomography were used to diagnose, localize, and guide the percutaneous drainage of 24 intraabdominal and retroperitoneal abscesses in 23 surgical and medical inpatients 16 of whom had abscess formation as a postoperative complication. On the basis of anatomic detail from sectional imaging, safe percutaneous drainage routes similar to surgical approaches were defined. After confirmation by needle aspiration, one of two methods of percutaneous catheter introduction were used: (1) a modified Seldinger technique for placement of an 8 French pigtail catheter and (2) a trocar catheter technique for placement of a 12 or 16 French catheter. Once in position, the catheters were managed as a surgically placed drain. In 22 of 24 cases, percutaneous catheter drainage was curative with no surgery required. There were no deaths or recurrences with an average follow-up period of 12 months ranging from 1 week to 3 years. Percutaneous aspiration and drainage should be considered as an alternative to surgery in the treatment of intraabdominal or retroperitoneal abscess.