CT-guided Catheter Research Articles

The Effect of CT-Guided Artificial Pneumothorax plus Thoracoscopy and Central Venous Catheterization on the Drainage Effect of Pediatric Empyema and Pulmonary Function.

The aim of the study is to investigate the effect of CT-guided artificial pneumothorax combined with a thoracoscopic and central venous catheter on empyema drainage effect and pulmonary function in children. A total of 82 pediatric patients with empyema admitted to our hospital from January 2020 to December 2021 were retrospectively analyzed. The control group was treated with artificial pneumothorax combined with thoracoscopy. The study group was treated with a CT-guided and central venous catheter. The operation time, intraoperative bleeding, surgical field exposure, WBC, C-reactive protein, and pulmonary function were compared between the two groups. The size of effusion and sonographic staging were compared between the two groups. All children underwent spirometry and a maximal incremental cardiopulmonary exercise test. The operation indicators (operation time, intraoperative blood loss, etc.) and adverse reactions were compared between the two groups. The differences in the operation time, intraoperative blood loss, postoperative hospital stay, postoperative drainage volume, and surgical field exposure between the two groups had a statistical significance (P < 0.05); the differences in the body temperature, total peripheral white blood cell count, C-reactive protein, size of effusion, and sonographic staging between the two groups had no statistical significance (P > 0.05); before operation, the differences in the expression levels of FVC (%), FEV1 (%), FEV1/FVC, and MVV (%) and indicators of cardiopulmonary function including VE/VO2, breathing reserve(%), VD/VT(%), and VO2/work between the two groups had no statistical significance, but at 6 months after operation, FVC (%), FEV1 (%), FEV1/FVC, and MVV (%) in the study group were significantly higher than those in the control group (P < 0.05) and VE/VO2 and VD/VT(%) in the study group were obviously lower than those in the control group (P < 0.05); the incidence rate of chest pain, pulmonary edema, and skin infection in the study group was lower than that in the control group (P < 0.05). CT-guided artificial pneumothorax combined with thoracoscopic and central venous catheter drainage of empyema in children is more thorough, with less bleeding, less trauma, rapid recovery of pulmonary function, and is worthy of clinical promotion.

CT-Guided Transhepatic Catheter Drainage of Deep Postoperative Collections: Initial Experience

Abstract Purpose This article assesses the safety and utility of transhepatic drainage of deep seated postoperative intra-abdominal collections under computed tomography (CT) guidance in a short series. Methods This retrospective study included five patients (mean age: 45.8 years; 3 males, 2 females) who underwent CT-guided transhepatic drainage of postoperative abdominal abscess in our department between April 2019 and December 2020. The clinical and surgical details and the details of the transhepatic drainage procedure were evaluated along with success rates and complications. Results The surgical procedures were Whipple's pancreaticoduodenectomy in four patients and gastrectomy in one patient. Four out of five abscesses were drained through the right lobe of liver, while one was through the left lobe with a technical success rate of 100%. The mean total time for catheter drainage procedure including patient positioning and preparation was 29.2 minutes. None of the patients had procedure-related complications. Mean duration of catheter drainage was 12 days. All patients had complete resolution of symptoms after drainage and the clinical success rate was 100%. Conclusion Transhepatic approach is safe and effective for the drainage of inaccessible postoperative abdominal collections or abscesses where a standard percutaneous approach is not possible.

Value of spectral detector computed tomography to differentiate infected from noninfected thoracoabominal fluid collections

PurposeTo investigate the diagnostic value of spectral detector CT (SDCT)-derived virtual non-contrast (VNC), virtual monoenergetic images (VMI) and iodine overlays (IO) for distinguishing infected from noninfected fluid collections (FC) in the chest or abdomen. MethodThis retrospective study included 58 patients with venous phase SDCT with 77 FC. For all included FC, microbiological analysis of aspirated fluid served as reference. For quantitative analysis, wall thickness was measured, and (ROI)-based analysis performed within the fluid, the FC’s wall (if any) and the aorta. Two radiologists qualitatively evaluated visibility of wall enhancement, diagnostic confidence regarding infection of fluid collection, confidence of CT-guided drainage catheter placement and visibility of anatomical landmarks in conventional images (CI) and VNC, VMI40keV, IO. ResultsWall thickness significantly differed between infected (n = 46) and noninfected (n = 31) FC (3.5 ± 1.8 mm vs. 1.4 ± 1.8 mm, AUC = 0.81; p < 0.05). Fluid attenuation and wall enhancement was significantly higher in infected as compared to noninfected FC in all reconstructions (p < 0.05, respectively). Highest AUC regarding A) attenuation in fluid was yielded in CI and VMI70,80keV (0.75); B) wall enhancement in CI (0.88) followed by iodine concentration (0.86). Contrast-to-noise ratio of wall vs. fluid was highest in VMI40keV (p < 0.05). All assessed qualitative parameters received significantly higher ratings when using spectral reconstructions vs. CI (p for all <0.05), except for visibility of wall enhancement. ConclusionSpectral reconstructions improve the assessment of infected from noninfected thoracoabdominal fluid collections and depiction of wall enhancement. Diagnostic performance of the quantitative measurements in spectral reconstructions were comparable with measurements in conventional images.

Computed Tomography–Guided Catheter Aspiration and Thrombolysis of Hypertensive Basal Ganglionic Hematomas: Technique and Short-Term Outcome Comparison

Minimally invasive techniques of hematoma evacuation with or without the use of thrombolytic agents to lyse the clots have shown promising outcomes compared to open surgical evacuation. However, there is a dearth of literature in developing nations. The objective in this study was to evacuate spontaneous hypertensive basal ganglionic hemorrhages using computed tomography (CT)-guided catheter insertion, hematoma aspiration, and lysis with thrombolytic agents and analyze the efficacy and outcomes. Ten patients with spontaneous basal ganglionic hemorrhage underwent CT-guided clot catheter insertion, followed by aspiration of hematoma and clot lysis using 25,000 IU urokinase instilled every 12 hours. Details including symptoms, clinical and radiologic findings, efficacy of the technique, functional outcomes during follow-up, length of stay, and cost were recorded. Relevant details for 12 age- and sex-matched conservatively treated patients were compared. Functional outcome in the catheter group at 6 months was better than the medically managed group, with improved mean Glasgow Outcome Scale score (0.4 vs. 0.08), reduced modified Rankin scale score (-0.8 vs.-0.25), and reduced National Institutes of Health Stroke Scale score (-6.8 vs.-1.5 points). However, it was not statistically significant. Average hematoma volume reduction in the catheter group was 83.14%. In the medically managed group, 2 of 12 patients (16.6%) had hematoma expansion, 6 patients (50%) developed hydrocephalus, and 2 patients (16.6%) died. In the catheter group, 4 of 10 patients (40%) developed mild pneumocephalus that resolved. The evacuation of hypertensive basal ganglionic hematomas is feasible with basic neurosurgical instruments and existing resources (e.g., CT scan) with improved functional outcome compared with conservative treatment alone.

GIRAFFE IN THE COVID-19 LUNG: PULMONARY FIBROSIS LIMITING SEVERITY OF THE PNEUMOTHORAX

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: More than a year has passed since the first reported cases of COVID-19 worldwide. We present a case of a patient with COVID-19 who acquired bilateral pulmonary fibrosis then later developed a pneumothorax of the right lung. Ironically, it was this fibrosis that prevented a catastrophic collapse of the lung. CASE PRESENTATION: This is a 60-year-old Caucasian female with hypertension, type II diabetes mellitus and obstructive sleep apnea (OSA) who was admitted due to a four-day history of worsening shortness of breath four days due to COVID pneumonia. She was admitted to the ICU due to worsening respiratory status and was maintained on bi-level positive airway pressure ventilation (BIPAP) for two weeks. Repeated chest radiographs in the ICU showed diffuse infiltrates with ground glass opacities bilaterally. She began to improve on the 3rd week of hospitalization, allowing titration down to high flow nasal cannula with BIPAP at night for OSA. On the 4th week, a routine chest radiograph incidentally revealed a small right apical pneumothorax. She had no desaturations, tachypnea, or increased work of breathing at this time. A CT scan of the chest confirmed the extensive pulmonary fibrosis and ground glass opacities and demonstrated the pneumothorax (Figure 1). A repeat 36 hour chest radiograph (Figure 2) showed expansion of the pneumothorax to a volume of 25% of the right hemithorax, with no signs of tension. The patient's clinical status remained unchanged. Follow-up chest CT scan (Figure 1) showed fibrotic attachments tethering the lungs to the pleura that may have limited its further collapse. Patient underwent a CT-guided pigtail catheter insertion the same day. Follow-up imaging the next day confirmed resolution of the pneumothorax. The pigtail catheter was later removed. The patient remained hospitalized, but improving. DISCUSSION: Pulmonary fibrosis is a known sequelae of COVID pneumonia. Bullae and cyst formation can form as a result of this extensive airspace disease. Secondary spontaneous pneumothorax in COVID-19 could be due to damage to the subpleural alveoli from the formation of cysts and bullae leading to spontaneous alveolar rupture into the pleural space. The use of BIPAP could have contributed to it, due to additional volume and barotrauma. Our patient developed pulmonary fibrosis after remaining hospitalized for more than 4 weeks. The fibrosis caused the lung to tether to portions of the pleura, preventing a quick, catastrophic collapse of the lung. The delay in progression gave the patient an opportunity to undergo a CT-guided pigtail catheter insertion, as opposed to an emergent chest tube thoracostomy which would have been a more invasive, traumatic, and painful procedure. CONCLUSIONS: This case highlights the possibility of extensive lung fibrosis, via thick pleural adhesions, protecting patients from developing fatal pneumothorax. REFERENCE #1: Wu, C., et al., Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med, 2020. 180(7): p. 934-943. REFERENCE #2: Rai, D.K., P. Sharma, and R. Kumar, Post covid 19 pulmonary fibrosis- Is it reversible? Indian Journal of Tuberculosis, 2020. REFERENCE #3: Martinelli, A.W., et al., COVID-19 and pneumothorax: a multicentre retrospective case series. Eur Respir J, 2020. 56(5) DISCLOSURES: No relevant relationships by Patrick Benjamin, source=Web Response No relevant relationships by Marvyn Allen Chan, source=Web Response No relevant relationships by Josemaria Demigillo, source=Web Response No relevant relationships by Ma Pamela Demigillo, source=Web Response No relevant relationships by Stephen Jesmajian, source=Web Response No relevant relationships by Junfeng Xue, source=Web Response

Complications of Computed Tomography-Guided High-Dose-Rate Brachytherapy (CT-HDRBT) and Risk Factors: Results from More than 10 Years of Experience.

For local ablation of unresectable tumors, computed tomography-guided high-dose-rate brachytherapy (CT-HDRBT) is a minimally invasive therapeutic option involving CT-guided catheter placement and high-dose-rate irradiation with iridium-192. Possible complications are related to transcutaneous puncture, retraction of the applicator, and delivery of brachytherapy. To classify CT-HDRBT in comparison with other minimally invasive therapeutic options, it is essential to know the probability of complications and their risk factors. This study therefore aimed at quantifying the occurrence of complications in CT-HDRBT and identifying potential risk factors. Over a period of more than 10years from 2006 to 2017, 1877 consecutive CT-HDRBTs were performed at our center and retrospectively analyzed. In 165 cases, CT-HDRBT was combined with transarterial (chemo-) embolization. Information on complications and potential risk factors was retrospectively retrieved from electronic documentation. Statistical analysis of the data was performed. No complications occurred in 85.6% of the interventions. The most common complications were bleeding (5.6%), infection (2.0%), and prolonged pain (1.5%). Summarized diameter (defined as sum of maximum diameters in axial orientation) of treated tumor lesions (odds ratio 1.008; p < 0.001), target lesion site (odds ratio 1.132; p = 0.033), combined treatment (odds ratio 1.233; p = 0.038), and the presence of biliodigestive anastomosis (BDA) (odds ratio 1.824; p = 0.025) were identified as risk factors. CT-HDRBT is a safe minimally invasive therapeutic option. Summarized diameter of treated tumor lesions, target lesion site, combined treatment, and presence of BDA are risk factors for complications.

2319 A Case of Cryptogenic Liver Abscess in a Young Uncontrolled Diabetic

INTRODUCTION: Pyogenic liver abscess (PLA) is a rare complication of Diabetes Mellitus, usually seen in older adults who have had diabetes for many years. There is little information regarding the effects of glycemic control on the characteristics of PLA in diabetic patients. Actinomycosis is an infrequent invasive bacterial disease with indolent and non-specific presentation, therefore diagnosis is quite difficult to make for clinicians. Here, we report an uncontrolled diabetic patient who developed cryptogenic Actinomyces odontolyticus bacteremia and concurrent polymicrobial liver abscess. CASE DESCRIPTION/METHODS: A 41-year-old male with a history of uncontrolled Diabetes Mellitus Type 2, presented with severe, dull, epigastric pain. He was found to be in septic shock and diabetic ketoacidosis, requiring admission to the medical intensive care unit. Initial laboratory tests showed a white blood cell count of 16,800/mm3 (87% neutrophils), bicarbonate 14mmol/L, AST 147, ALT 126, alkaline phosphatase 193, beta hydroxybutyrate 5.04, and anion gap 17. HIV testing was negative. Hemoglobin A1c was 13%. A computed tomography (CT) image of his abdomen revealed a 7cm gas containing lesion in the left hepatic lobe concerning for hepatic abscess. He was started on empirica vancomycin and piperacillin/tazobactam and subsequently underwent CT-guided pigtail catheter insertion for drainage of the abscess. Microbiological examination of the drainage revealed polymicrobial pus including rare actinomyces. His blood cultures revealed actinomyces odontolyticus. He improved hemodynamically and repeat blood cultures were negative. He was discharged on IV Penicillin G and Metronidazole with duration dependent on resolution of abscess. Once infection is resolved, he will undergo colonoscopy and dental examination to identify possible source for infection. DISCUSSION: The incidence and morbidity of patients with PLA and diabetes has recently increased. Hyperglycemia can promote bacterial growth in tissues, and metabolic disorders impact the gastrointestinal tract. Diabetes can also promote infection through reduced immunity, neutrophil chemotaxis, mononuclear phagocyte activation, and opsonization. Actinomyces Odontolyticus is rare, especially in the absence of other pathology, and many conditions have been described as a possible initiating event including diverticulitis, appendicitis or peptic ulcer disease. A multi-team approach is always recommended when disseminated actinomycotic infection is observed.

Canceled or aborted CT-guided interventions: 13-year clinical experience at a tertiary care center.

To determine the frequency and causes of canceled or aborted CT-guided interventions (biopsies, cytological aspirations, hookwire localizations, and catheter drainages), associations with patient and procedural variables, and subsequent management. This study included 3052 consecutive CT-guided interventions (2487 biopsies, 80 cytological aspirations, 223 hookwire localizations, and 262 catheter drainages) performed in a single institution within a 13-year period. Fifty-two of 3052 CT-guided interventions were canceled or aborted, corresponding to a frequency of 1.7% (95% confidence interval [CI] 1.3-2.2%). Main causes in order of decreasing frequency included pain, lack of a safe window for intervention, impossibility to position the co-axial or biopsy needle in or near the target, inability to lie still, dyspnea and low oxygen saturation levels, non-discontinuation of anticoagulant therapy, impossibility to aspirate fluid or pus when attempting drainage, and impossibility to advance the drainage catheter in a fluid collection or abscess. On multivariate analysis, only catheter drainages and head-neck interventions were significantly at risk (p = 0.019 and p = 0.004) to be canceled or aborted, with odds ratios of 2.677 (95% CI 1.178-6.083) and 6.956 (95% CI 1.883-25.691), respectively. Of 52 canceled or aborted CT-guided interventions, 14 (26.9%) were repeated, 19 (36.5%) underwent a different non-CT-guided interventional procedure on the same target, and 19 (36.5%) did not undergo any subsequent intervention. The frequency of canceled or aborted CT-guided interventions is low, but is not negligible. Awareness of causes and circumstances under which they are more likely to occur may reduce the number of canceled or aborted CT-guided interventions. • Approximately 1.7% of CT-guided interventions, for which the patient physically shows up at the CT room and which are considered useful by the radiologist, are eventually canceled or aborted. • Main causes (of which some may be prevented) are pain, lack of a safe window, impossibility to position the co-axial or biopsy needle, inability to lie still, dyspnea, non-discontinuation of anticoagulant therapy, and impossibility to aspirate liquid or advance the catheter when attempting drainage. • CT-guided catheter drainages and head-neck interventions are particularly prone to being canceled or aborted.

CT-Guided Translumbar Placement of Permanent Catheters in the Inferior Vena Cava: Description of the Technique with Technical Success and Complications Data.

To evaluate indications, technical success rate and complications of CT-guided translumbar catheter placement in the inferior vena cava for long-term central venous access (Port and Hickman catheters) as a bail-out approach in patients with no alternative options for permanent central venous access. This retrospective study included 12 patients with a total of 17 interventions. All patients suffered from bilaterally chronically occluded venous vessels of their upper extremities, without patent internal jugular and/or subclavian veins. Catheter implantation was performed as a hybrid procedure with CT-guided translumbar access into the inferior vena cava with subsequent angiography-guided catheter placement of a Hickman-type catheter (7×) or a Port catheter (10×). All interventions were technically successful. The total 30-day complication rate was 11.8% (n = 2). The two detected complications were bleeding at the subcutaneous port hub and subcutaneous kinking of the venous tube. Mean follow-up time was 68.4 ± 41.4months (range 3.4-160months). Six patients (50%) died during follow-up from non-procedure-related complications associated with the underlying disease. Late complications occurred in 8/17 (47.1%) cases and were infections of the catheter system in 35.3% (n = 6), mechanical defect of the catheter system in 5.8% (n = 1) and dislocation of the catheter system in 5.8% (n = 1). The overall infection rate was 0.77 per 1000 catheter days. CT-guided translumbar placement of permanent catheters is a technically feasible and safe method for permanent central venous access as last resort in chronically occluded veins of the upper extremities.

Computerized Tomography-Guided Paracentesis: An Effective Alternative to Bedside Paracentesis?

BackgroundAscites remains the most common cause of hospitalization among patients with decompensated cirrhosis. Paracentesis is a relatively safe procedure with low complication rates. Computerized tomography (CT)-guided therapeutic paracentesis could be a safe and effective alternative to unaided or aided (ultrasonogram-guided) bedside paracentesis. In this retrospective study, we aimed to compare the efficacy, safety, and cost-effectiveness of CT-guided paracentesis with bedside paracentesis.MethodsThe period of study was from 2002 to 2012. All patients with cirrhosis who underwent therapeutic paracentesis were included in the study. These patients were divided into two groups. Group I consisted of patients who underwent CT-guided pigtail catheter insertion with ascitic fluid drainage. Group II consisted of patients who underwent beside therapeutic paracentesis after localization of fluid either by physical examination or sonographic localization. We measured the efficacy of CT-guided paracentesis and bedside paracentesis in terms of volume of fluid removed, length of stay, discharge doses of diuretics (spironolactone and furosemide) and number of days to readmission for symptomatic ascites. We also computed the cost-effectiveness of CT-guided therapeutic paracentesis when compared to a bedside procedure. Fischer exact test was used to analyze the distribution of categorical data and unpaired t-test was used for comparison of means.ResultsThere were a total of 546 unique patients with diagnosed cirrhosis who were admitted to the hospital with symptomatic ascites and underwent therapeutic paracentesis. Two hundred and forty-seven patients underwent CT-guided paracentesis, while 272 patients underwent bedside paracentesis. There was significant inverse correlation between the amount of ascitic fluid removed and total length of stay in the hospital. We found that the volume of fluid removed via a CT-guided pigtail insertion and drainage (2.72 ± 2.02 L) is significantly higher when compared to fluid removed via bedside paracentesis (1.94 ± 1.69). We also found that the interval time period between two successive therapeutic paracenteses was significantly longer for CT group (106.56 ± 75.2 days) when compared to the bedside group (25.57 ± 7.68 days).ConclusionCT-guided paracentesis with pigtail catheter insertion and drainage is a clinically effective, cheap and safe alternative to conventional bedside paracentesis.

Non-Surgical Management of Critically Compromised Airway Due to Dilatation of Interposed Colon.

We present a rare case of critically compromised airway secondary to a massively dilated sequestered colon conduit after several revision surgeries. A 71-year-old male patient had several operations after the diagnosis of gastric cancer. After initial treatment of pneumonia in the pulmonology department, he was transferred to the surgery department for feeding jejunostomy because of recurrent aspiration. However, he had respiratory failure requiring mechanical ventilation. The chest computed tomography (CT) scan showed pneumonic consolidation at both lower lungs and massive dilatation of the substernal interposed colon compressing the trachea. The dilated interposed colon was originated from the right colon, which was sequestered after the recent esophageal reconstruction with left colon interposition resulting blind pouch at both ends. It was treated with CT-guided pigtail catheter drainage via right supraclavicular route, which was left in place for 2 weeks, and then removed. The patient remained well clinically, and was discharged home.

Unresectable Colorectal Liver Metastases: Percutaneous Ablation Using CT-Guided High-Dose-Rate Brachytherapy (CT-HDBRT)

To evaluate the clinical outcome of CT-guided high-dose-rate brachytherapy (CT-HDRBT) of unresectable colorectal liver metastases (CRLMs). Retrospective analysis of all consecutive patients with unresectable CRLMs treated with CT-HDRBT between January 2008 and November 2012. Treatment was performed by CT-guided catheter placement and high-dose-rate brachytherapy with an iridium-192 source. MRI follow-up was performed after 6 weeks and then every 3 months post-intervention. The primary endpoint was local tumor control (LTC); secondary endpoints included time to progression (TTP) and overall survival (OS). 80 heavily pretreated patients with 179 metastases were available for MRI evaluation for a mean follow-up time of 16.9 months. The mean tumor diameter was 28.5 mm (range: 8 - 107 mm). No major complications were observed. A total of 23 (12.9 %) local tumor progressions were observed. Lesions ≥ 4 cm in diameter showed significantly more local progression than smaller lesions (< 4 cm). 50 patients (62.5 %) experienced systemic tumor progression. The median TTP was 6 months. 28 (43 %) patients died during the follow-up period. The median OS after ablation was 18 months. CT-HDRBT is an effective technique for the treatment of unresectable CRLMs and warrants promising LTC rates compared to thermal ablative techniques. A combination with other local and systemic therapies should be evaluated in patients with lesions > 4 cm in diameter, in which higher progression rates are expected. • CT-HDRBT enables a highly cytotoxic irradiation of colorectal liver metastases with simultaneous conservation of important neighboring structures (eg liver parenchyma, bile ducts and bowel)• The local tumor control rates obtained by CT-HDRBT in patients with colorectal liver metastases are promising, also compared to the local tumor control rates after RFA• Metastases with a diameter of 4 cm or abow, display a higher local progression rate after CT-HDRBT, therefor a combination therapy with other locoregional or systemic treatments should be investigated in prospective studies.

Clinical outcomes of high-dose-rate interstitial gynecologic brachytherapy using real-time CT guidance

To evaluate clinical outcomes of CT-guided high-dose-rate (HDR) interstitial brachytherapy for primary and recurrent gynecologic cancer. Records were reviewed for 68 women (34 with primary disease and 34 with recurrence) treated with CT-guided HDR interstitial brachytherapy between May 2005 and September 2011. Interstitial application was performed under general anesthesia using an iterative approach of catheter insertion and adjustment with serial image acquisition by CT in a dedicated brachytherapy suite. The median fractional brachytherapy dose was 3.9Gy delivered twice daily in seven fractions. The median cumulative dose in equivalent 2-Gy fractions was 74.8Gy. Actuarial survival estimates were calculated using the Kaplan-Meier method, and toxicity was reported by Common Toxicity Criteria. Primary disease sites were endometrial (34), cervical (17), vaginal (11), ovarian (3), and vulvar (3). Median age was 61.5 years, and tumor size at diagnosis was 3.4cm. Median D90 and V100 were 73.6Gy and 87.5%, respectively; median D2cc for bladder, rectum, and sigmoid were 67.1, 64.6, and 53.7Gy, respectively. With a median followup of 17 months, actuarial rates of local control, progression-free survival, and overall survival at 2 years for all patients were 86%, 60%, and 64%, respectively. There were 9 grade 3 late toxicities (six gastrointestinal and three vulvovaginal). HDR interstitial brachytherapy with CT-guided catheter placement results in acceptable local control, toxicity, and survival rates for women with primary or recurrent gynecologic cancer. Durable pelvic control may be achieved in most patients with this specialized brachytherapy technique.

Efficacy of three different surgical methods in treatment for bacteria liver abscess

Objective To discuss the clinical effect of the ultrasound or CT-guided percutaneous pus or catheter drainage (CT-PDLA),laparoscopic liver abscess drainage (LD-LA) and abdominal liver abscess incision and drainage (IDLA).Methods 103 cases of pyogenic liver abscess were randomly divided into three groups,which were CT-PDLA group (Group A,35 cases),LD-LA group (Group B,n =34 cases) and IDLA group (Group C,34 cases),and the clinical effects of three groups were compared.Results All patients were cured,the total efficiency of Group A was 100％,Group B for 97.06％,Group C for 82.35％,there was statistical significant difference between them (P＜0.05),but there was no significant difference between Group A and Group B(P＞0.05),there were no significant difference in the biochemical markers of three groups(P＞0.05),for the after conventional indicators,Group A was better than that Group B and Group C (P＜0.05).Conclusion Under the same conditions,exact indications,the CT-PDLA treatment BLA is reliable,simple,economical,having advantages of small trauma,low complications and high cure rate,which can be the preferred treatment choice for bacterial liver abscess. Key words: Bacterial liver abscess; Ultrasound-guided; Laparoscopic drainage; Open drainage

Abstract No. 387: Simulation training in percutaneous image-guided interventions

Users will gain familiarity with key technical aspects and necessary steps required for percutaneous image-guided interventions, namely the placement of an abscess drainage catheter. Current limitations in resident work hours, though essential for physician health and decision-making, has unfortunately resulted in decreased hands on procedural and operative experience. This paradigm shift has resulted in the need for accurate simulation modules to allow the training physician to both learn the steps of procedures as well as develop comfort in its technical aspects. We have developed a software application that simulates the sequential steps required for percutaneous image-guided interventions. The program was written in the Adobe Flash environment to construct an interactive graphical display interface (GUI) to enhance the user experience. Our training module simulates the deployment of a CT-guided drainage catheter. Briefly, a video of an actual abscess drainage case was recorded after obtaining patient consent. The video was subsequently edited and imported into our software program, which also utilizes a list of images that a user can select from the computer screen. Each image, which represents a key step in the procedure, is temporally synchronized to its appropriate position in the video. For instance, an image of a biopsy grid may be associated with video playback demonstrating the technique of localizing proper site of percutaneous access. The list of images is randomized, and the simulation will only proceed forward if the end user selects the correct chronologic sequence of steps. Lastly, a narrative is provided throughout the video to provide more details on each step. Simulation technologies play an integral role in medical training and practice. We have developed a training module that simulates the sequential steps required in the placement of a CT-guided percutaneous drainage catheter.

Abstract No. 386: Percutaneous vertebroplasty performed with an 18 G needle for the treatment of severe compression fracture of cervical vertebral body due to malignancy

No. 386 Percutaneous vertebroplasty performed with an 18 G needle for the treatment of severe compression fracture of cervical vertebral body due to malignancy L. Chen, R. Ni; Interventional Radiology, The First Affiliated Hospital of Suzhou University, SuZhou, China Purpose: Percutaneous vertebroplasty (PVP) provides pain relief and strengthening of the bone of vertebrae weakened by disease. It is increasingly accepted as one of the treatment options in the management of intractable pain due to vertebral compression. Severe vertebral compression, refers to vertebral body collapse to less than one-third of its original height and is considered to be a situation in which PVP is technically difficult to perform, especially for the treatment of cervical vertebral body. The purpose of this study was to investigate the clinical feasibility and efficacy of PVP performed with an 18G needle for the treatment of severe compression fractures of cervical vertebral body due to malignancy. Materials and Methods: PVP was performed in 4 patients with severe compression fractures of cervical vertebral body due to malignanc. A total of 5 diseased vertebral bodies were detected, which distributed in the C5 (n 1), C6 (n 3), C7 (n 1) vertebral bodies. Under fluoroscopic guidance an 18G needle was punctured into the target vertebral body and then polymethylmethacrylate bone cement was in. A follow-up lasting for one month was conducted. Results: The technical success of both needle puncturing and bone cement injection was achieved in all patients. The mean amount of bone cement injected in each diseased vertebra was 2.2 ml (1.5 3.2)m1. Marked pain relief was quickly obtained in all 4 patients. No major complications occurred in this series, except for asymptomatic bone cement leaking around vertebra which appeared in one vertebral bodies. Conclusion: PVP with 18G needle is a safe, effective technique in treating the malignant severe cervical vertebral body compression fractures. Educational Exhibit Abstract No. 387 Simulation training in percutaneous image-guided interventions J. Ghassemi, B. Jeun, B.B. Pua; Radiology, Weill Cornell Medical Center, New York, NY Learning Objectives: Users will gain familiarity with key technical aspects and necessary steps required for percutaneous imageguided interventions, namely the placement of an abscess drainage catheter. Background: Current limitations in resident work hours, though essential for physician health and decision-making, has unfortunately resulted in decreased hands on procedural and operative experience. This paradigm shift has resulted in the need for accurate simulation modules to allow the training physician to both learn the steps of procedures as well as develop comfort in its technical aspects. We have developed a software application that simulates the sequential steps required for percutaneous image-guided interventions. The program was written in the Adobe Flash environment to construct an interactive graphical display interface (GUI) to enhance the user experience. Clinical Findings/Procedure Details: Our training module simulates the deployment of a CT-guided drainage catheter. Briefly, a video of an actual abscess drainage case was recorded after obtaining patient consent. The video was subsequently edited and imported into our software program, which also utilizes a list of images that a user can select from the computer screen. Each image, which represents a key step in the procedure, is temporally synchronized to its appropriate position in the video. For instance, an image of a biopsy grid may be associated with video playback demonstrating the technique of localizing proper site of percutaneous access. The list of images is randomized, and the simulation will only proceed forward if the end user selects the correct chronologic sequence of steps. Lastly, a narrative is provided throughout the video to provide more details on each step. Conclusion and/or Teaching Points: Simulation technologies play an integral role in medical training and practice. We have developed a training module that simulates the sequential steps required in the placement of a CT-guided percutaneous drainage catheter. Educational Exhibit Abstract No. 388 Complications of percutaneous radiological gastrostomy/gastrojejunostomy tube insertions: S154 Poster Sessions JVIR Po st er Se ss io ns

Antibiotics and Drainage for Treating Stent-Graft Infection after EVAR

The patient was a 64-year-old man. He developed fever and lumbago 6 months after the EVAR. Because CT showed an abscess in the aortic aneurysm surrounding the stent graft, stent-graft infection was diagnosed, and treatment with intravenous antibiotics was initiated. However, the fever and inflammatory markers persisted; therefore, CT-guided drainage catheter placement was performed. After all the pus had been discharged, the fever subsided, and the inflammatory reaction was also suppressed. One year has elapsed since the treatment, and the patient continues to visit with no complaints. We report that stent-graft infection was relieved with antibiotics and drainage.

Percutaneous Management of Postoperative Bile Leaks After Upper Gastrointestinal Surgery

This study was designed to investigate the benefit of percutaneous interventional management of patients with postoperative bile leak on clinical outcome. Primary study endpoints were closure of the bile leak and duration of percutaneous transhepatic biliary drainage (PTBD) treatment. Secondary study endpoints were necessity of additional CT-guided drainage catheter placement, course of serum CRP level as parameter for inflammation, and patients' survival. Between January 2004 and April 2008, all patients who underwent PTBD placement after upper gastrointestinal surgery were analyzed regarding site of bile leak and previous attempt of operative bile leak repair, interval between initial surgery and PTBD placement, procedural interventional management, course of inflammation parameters, duration of PTBD therapy, PTBD-related complications, and patients' survival. Thirty patients underwent PTBD placement for treatment of postoperative bile leaks. In 12 patients (40%), PTBD was performed secondary to a surgical attempt of bile leak repair. Additional percutaneous drainage of bilomas was performed in 14 patients (47%). CRP serum level decreased from 138.1 ± 73.4 mg/l before PTBD placement to 43.5 ± 33.4 mg/l 30 days after PTBD placement. The mean duration of PTBD treatment was 55.2 ± 32.5 days in the surviving patients. In one patient, a delayed stenosis of the bile duct required balloon dilation. Two PTBD-related complications (portobiliary fistula, hepatic artery aneurysm) occurred, which were successfully treated by embolization. Overall survival was 73% (22 patients). PTBD treatment is an effective therapy. PTBD treatment and additional CT-guided drainage of bilomas helped to reduce intraabdominal inflammation, as shown by reduction of inflammation parameters.

The Interventional Radiological Procedures of the Infections of Pancreas

Infected necrotizing pancreatitis is the most severe form of acute pancreatitis and is related with high rates of morbidity and mortality. The close cooperation and communication, working as a team, among interventional radiologists surgeons and gastroenterologists improves the successful treatment considerably. Therapeutic modalities such as percutaneous CT-guided catheter drainage can be helpful to save lives, changing dramatically the clinical aspect of the patient. The objective of this paper is to review the indications and techniques of image-guided percutaneous treatment of pancreatic infected pseudocysts and to report our clinical experience and observations made during primary CT-guided percutaneous catheter drainage of infected abscesses.

Infected Necrosis in Severe Pancreatitis —Combined Nonsurgical Multi-Drainage with Directed Transabdominal High-Volume Lavage in Critically III Patients

Background: Infection of pancreatic necrosis is a life-threatening complication during the course of acute pancreatitis. In critically ill patients, surgical or extended endoscopic interventions are associated with high morbidity and mortality. Minimally invasive procedures on the other hand are often insufficient in patients suffering from large necrotic areas containing solid or purulent material. We present a strategy combining percutaneous and transgastric drainage with continuous high-volume lavage for treatment of extended necroses and liquid collections in a series of patients with severe acute pancreatitis. Patients and Methods: Seven consecutive patients with severe acute pancreatitis and large confluent infected pancreatic necrosis were enrolled. In all cases, the first therapeutic procedure was placement of a CT-guided drainage catheter into the fluid collection surrounding peripancreatic necrosis. Thereafter, a second endosonographically guided drainage was inserted via the gastric or the duodenal wall. After communication between the separate drains had been proven, an external to internal directed high-volume lavage with a daily volume of 500 ml up to 2,000 ml was started. Results: In all patients, pancreatic necrosis/liquid collections could be resolved completely bythe presented regime. No patientdied in the course of our study. After initiation of the directed high-volume lavage, there was a significant clinical improvement in all patients. Double drainage was performed for a median of 101 days, high-volume lavage for a median of 41 days. Several endoscopie interventions for stent replacement were required (median 8). Complications such as bleeding or perforation could be managed endoscopically, and no subsequent surgical therapy was necessary. All patients could be dismissed from the hospital after a median duration of 78 days. Conclusion: This approach of combined percutaneous/endoscopic drainage with high-volume lavage shows promising results in critically ill patients with extended infected pancreatic necrosis and high risk of surgical intervention. Neither surgical nor endoscopie necrosectomy was necessary in any of our patients.