Treatment of breast abscesses with sonographically guided aspiration, irrigation, and instillation of antibiotics

OBJECTIVE: We studied the feasibility of treating breast abscesses with sonographically guided aspiration, irrigation, and local instillation of antibiotics without placing indwelling catheters. MATERIALS AND METHODS: Seventy-three patients with breast abscesses were seen from 1995 to 2001. Aspiration and irrigation were performed under sonographic guidance. Repeated aspiration was performed when deemed necessary. One gram of cephradine was injected into 29 abscesses measuring more than 25 mm. RESULTS: Six patients refused further treatment after failure of the first aspiration and elected surgical drainage. Of the remaining 67 patients who completed treatment, 38 required one aspiration for cure, 18 required two aspirations, and eight required more than two aspirations. The treatment failed and surgical drainage was required in only three of the 67 patients completing treatment. CONCLUSION: Ninety-six percent of patients completing treatment were cured with this procedure. Local instillation of antibiotics is probably beneficial.     

Safety of sonographically guided aspiration of intramuscular, bursal, articular and subcutaneous hematomas

Objective

To evaluate the safety and efficacy of sonographically guided aspiration of intramuscular, bursal and subcutaneous hematomas.

Materials and methods

One hundred eleven interventions were performed in 75 patients at a single institution from January 2005 to December 2009. In all cases the target of interest was identified with ultrasonography.

Results

Ninety-six procedures (87.3%) were successful, 14 procedures (12.7%) were unsuccessful due to excessive density and/or viscosity of the content. No significant complications were encountered during or immediately after any procedure. Clinical follow-up records were available for 73 (75%) procedures in 45 (66%) patients, 30 patients did not return for follow-up after hematoma evacuation. No septic or hemorrhagic complications or cases of neurovascular compromise were recorded.

Conclusions

Sonographically guided hematoma evacuation is a safe procedure. However, the proportion of unsuccessful evacuations and hematoma recurrence is substantial.     

Renal cell carcinoma complicating long-term dialysis: computed tomography-guided aspiration cytology

The diagnosis of renal cell carcinoma was established by computed tomography-guided aspiration in two small solid lesions occurring in end-stage kidneys. This represents a safe means of providing more specific information about the various lesions that specific information about the various lesions that frequently develop in chronic hemodialysis patients: complex cysts, adenoma, and renal cell carcinoma. The proposed conservative approach of simple observation of these lesions may be altered if a precise diagnosis is obtained. Computed tomography is considered the most reliable imaging modality for evaluation and guided aspiration.     

Ultrasound-guided aspiration cytology of the spleen.

The cytologic results of ultrasound-guided fine-needle biopsies (FNB) of the spleen in 42 patients were analyzed retrospectively. A focal lesion was punctured in 28 of them, splenomegaly in 12, and an enlarged accessory spleen in 2. Sufficient material was aspirated for cytologic analysis in 41 (97.6%) cases. A final diagnosis of malignancy was made in 16 (38%), and a benign condition diagnosed in 26 (62%) patients. The sensitivity, specificity, and accuracy of the method for differentiating malignancy from benign conditions were 68.8%, 100%, and 88.1%, respectively. No complications occurred. We conclude that ultrasound-guided FNB is a safe, highly specific, but relatively insensitive method of defining splenic pathology.     

Symptomatic renal obstruction or urosepsis during pregnancy: treatment by sonographically guided percutaneous nephrostomy.

Seven pregnant women with symptomatic hydronephrosis had sonographically guided percutaneous nephrostomy for pyosepsis (five patients) or for pain with azotemia (two patients with renal transplants). Antibiotics had been ineffective in controlling pyosepsis in each patient; retrograde ureteral catheterization via cystoscopy was unsuccessful in one patient. After percutaneous nephrostomy, prompt clinical improvement was observed in all patients (i.e., sepsis was relieved and pain abated). Labor was not induced in any of the patients, and no adverse effects occurred to any fetus or mother. Eleven (eight percutaneous nephrostomy, three catheter exchanges) of the 12 procedures were done without conventional radiography and with sonographic guidance alone. After percutaneous nephrostomy, maneuvers to obtain a diagnosis and to treat the obstruction (if necessary) were delayed until after delivery. The causes of ureteral obstruction were calculi (four patients) and a gravid uterus (three patients). After delivery, stones were removed either percutaneously (one patient) or cystoscopically (two patients) or passed spontaneously (one patient); resolution of obstruction by the gravid uterus was proved by Whitaker test after delivery. Sonographically guided percutaneous nephrostomy is an effective and safe method to treat pregnant women who have symptomatic obstructive hydronephrosis associated with either pyosepsis or azotemia. The procedure is rapid, requires minimal anesthesia, has no radiation, and is safe for the fetus. The technique is a useful and perhaps preferable alternative to more invasive surgical therapy or retrograde stenting.     

Presacral myelolipoma in a patient with rectal cancer: diagnosis by magnetic resonance imaging and aspiration cytology

State-of-the-art magnetic resonance imaging (MRI) protocol for the evaluation of rectal cancer suggests only T2-weighted fast spin-echo sequences. We present a case of rectal cancer with a simultaneous presacral myelolipoma that could have been misdiagnosed on MRI as a metastasis if a T1-weighted sequence had not also been used in the evaluation.     

Posterior ankle impingement in professional soccer players: effectiveness of sonographically guided therapy

OBJECTIVE: The objective of our study was to describe the use of MRI and evaluate the efficacy of sonographically guided injection of steroid and anesthetic in the management of posterior ankle impingement in elite athletes. CONCLUSION: The results show a role for sonographically guided steroid and anesthetic injection into a posterolateral capsule abnormality in athletes with clinical posterior impingement. The procedure was well tolerated and allowed a rapid return to athletic activity in all patients.     

Sonographically guided aspiration cytology of neck nodes for selection of treatment and follow-up in patients with N0 head and neck cancer.

BACKGROUND AND PURPOSE: The management of the clinically negative neck (NO) remains controversial because the incidence of occult metastases is high and the prognostic difference between elective treatment and a "wait and see" approach remains unclear. This study was undertaken to assess the role of sonographically guided aspiration cytology for the selection of the initial-management strategy for the neck and for the early detection of neck metastases during follow-up of patients with NO. METHODS: Seventy-seven clinically and cytologically confirmed NO patients, who underwent a transoral tumor excision and no neck treatment, were followed up for 1 to 4 years by both palpation and sonographically guided aspiration cytology. RESULTS: Fourteen patients (18%) had recurrent neck tumor; 10 (71%) of these necks were salvaged. Of the 14 neck failures, six were detected before being palpable and nine were detected within 7 months. Eleven of the 19 aspirated tumor-positive nodes had a minimal diameter smaller than 1 cm, and all four patients who eventually died had lymph node metastases larger than 14 mm. CONCLUSION: With sonographically guided aspiration cytology, the risk of missing occult metastases was 18%, which is less than expected after palpation only. Sonographically guided aspiration cytology is an effective technique for following up on the status of the neck after transoral tumor excision, and should be used at frequent intervals if no elective neck treatment is performed.     

Carbon dioxide microbubbles-enhanced sonographically guided radiofrequency ablation: treatment of patients with local progression of hepatocellular carcinoma

Purpose The aim of our study was to evaluate the usefulness of percutaneous radiofrequency ablation (RFA) using CO₂ microbubbles-enhanced sonography for patients with local tumor progression of hepatocellular carcinoma (HCC). Materials and methods The tumors of 14 patients with local progression of HCC were treated with CO₂ microbubbles-enhanced RFA ablation via a catheter that had been placed in the hepatic artery. We assessed tumor detectability and technical effectiveness. The mean follow-up period was 14.1 months. Results Only 6 of the tumors could be found on conventional sonography, whereas 14 tumors were detected on CO₂ microbubbles-enhanced sonography. These 14 lesions were successfully treated with RFA guided by CO₂ microbubbles-guided sonography. Technical effectiveness was complete in all patients. No serious complications were observed, and there was no local tumor progression during the follow-up period. Conclusion RFA guided by CO₂ microbubbles-guided sonography is a feasible technique for treating local progression of HCC lesions that cannot be adequately depicted by conventional sonography.