CT-guided Percutaneous Aspiration Research Articles

S3669 Single-Culprit Pyogenic Liver Abscess Diagnosed by CT-Guided Percutaneous Aspiration: A Case Review

S3669 Single-Culprit Pyogenic Liver Abscess Diagnosed by CT-Guided Percutaneous Aspiration: A Case Review

Clinical characteristics and outcomes of pancreatic fungal infection in patients with necrotizing pancreatitis.

Pancreatic fungal infection (PFI) in patients with necrotizing pancreatitis can lead to significant morbidity and mortality. The incidence of PFI has increased during the past decade. Our study aimed to provide contemporary observations on the clinical characteristics and outcomes of PFI in comparison to pancreatic bacterial infection and necrotizing pancreatitis without infection. We conducted a retrospective study of patients with necrotizing pancreatitis (acute necrotic collection or walled-off necrosis), who underwent pancreatic intervention (necrosectomy and/or drainage) and had tissue/fluid culture between 2005 and 2021. We excluded patients with pancreatic procedures prior to hospitalization. Multivariable logistic and Cox regression models were fitted for in-hospital and 1-year survival outcomes. A total of 225 patients with necrotizing pancreatitis were included. Pancreatic fluid and/or tissue was obtained from endoscopic necrosectomy and/or drainage (76.0%), CT-guided percutaneous aspiration (20.9%), or surgical necrosectomy (3.1%). Nearly half of the patients had PFI with or without concomitant bacterial infection (48.0%), while the remaining patients had either bacterial infection alone (31.1%) or no infection (20.9%). In multivariable analysis to assess the risk of PFI or bacterial infection alone, only previous pancreatitis was associated with an increased odds of PFI vs. no infection (OR 4.07, 95% CI 1.13-14.69, p=.032). Multivariable regression analyses revealed no significant differences in in-hospital outcomes or one-year survival between the 3 groups. Pancreatic fungal infection occurred in nearly half of necrotizing pancreatitis. Contrary to many of the previous reports, there was no significant difference in important clinical outcomes between the PFI group and each of the other two groups.

A rare case report of ruptured splenic abscess causing pneumoperitoneum in a tertiary care centre

Splenic abscess is a very rare entity but potentially a life threatening disease. In autopsy studies, the incidence of splenic abscess is found to be 0.05 to 0.7%. The most common cause of splenic abscess is through haematogenous spread. It usually occurs due to spread of infection from endocarditis or some contiguous infection sites. High risk individuals include immunocompromised patients, hemoglobinopathies, and diabetes mellitus. Early in diagnosis of these abscesses can be done by the combination of clinical suspicion and computed tomography scan of the abdomen. The management of these abscesses includes medical therapy, CT-guided percutaneous aspiration, and splenectomy. Recent studies have stressed on the change in clinical spectrum, thereby indicating that intravenous antimicrobial therapy alone for patients with splenic abscess has a significant role in its management. However, many studies reveal that splenectomy is necessary for a ruptured splenic abscess with peritonitis.

1550. Beyond Skin Deep: Cellulitis Induced Splenic Abscess

BackgroundA 51 year old male presented with splenic abscess from chronic eczema with cellulitis.Coronal plane view of the CT abdomen showing the splenic abscess. CT abdomen without contrast in the transverse plane showed a splenic mass measuring 7.8 x 8.8 x 6.9 cm, similar in size to the results found on ultrasound examination. MethodsThe patient had poor medical compliance, diabetes, hypertension, hyperlipidemia, COPD, and chronic eczema with cellulitis presented with fever, malaise, abdominal pain and distension. The patient denied any previous intravenous drug use.CT abdomen showed a splenic mass measuring 7.8 x 8.8 x 6.9 cm. A TTE showed normal ejection fraction and normal mitral valve structure and function. The patient underwent a CT guided drainage with tube placement in the spleen. MRI of the spine showed some osteomyelitis of the L4 vertebrae, which likely developed from the splenic abscess. Subsequent cultures of the splenic abscess showed MRSA.Abdominal ultrasound with 2-D grayscale sector imaging shows a cystic mass in the spleen measuring roughly 8 x 8 x 6.5 cm in dimensions. No vascular flow was identified within the mass. CT chest showed a prominent left sided pleural effusion, lower lobe lung consolidation air bronchograms. An air-filled and regular cystic area in the posterior dependent portion of the left lower lobe was noted (possibly a small pneumatocele). Patchy infiltrates in right lung were noted as well. ResultsEndocarditis is the most common primary source of splenic abscess, with urinary tract infections, appendicitis, pneumonia, and wound infections as other primary etiologies. Organisms that can be involved are Streptococci, Staphylococci, and Escherichia coli, Enterococcus and Klebsiella pneumoniae.Splenic abscess follows a bimodal distribution, occuring in those younger than 40 and older than 70 years of age.Leukocytosis can be as high as the 18,000 cells/mL range or within the upper range of normal limits. The sensitivity of abdominal ultrasonography in the diagnosis of splenic abscesses is roughly 75-93%. The abdominal CT diagnostic sensitivity for splenic abscess ranges from 92-96%. In tandem with the ultrasound examination, the diagnostic sensitivity is estimated at 94.7%.Treatment options entail intravenous antibiotics with CT-guided percutaneous aspiration or splenectomy. Previous studies noted a 70.8-100% mortality rate in patients with splenic abscess who were treated only with intravenous antibiotics.MRI of the spine with contrast showing some probable small osteomyelitis of L4 vertebrae at the anterior/inferior corner. ConclusionCharacteristics of the patient population, geographic location, recent travel, possible vector exposures, predisposing medical conditions, and individual behaviors may be contributing factors in regards to the underlying etiologic organism(s) involved in each individual case of splenic abscess. This case study is especially rare in that the etiology of the splenic abscess was chronic eczematous cellulitis.Disclosures All Authors: No reported disclosures

S2802 Abdominal Actinomycosis Mimicking Malignancy

INTRODUCTION: The abdominal subtype of actinomycosis is extremely rare; however, when present can mimic intraabdominal malignancies. We present an 88-year-old woman who presented with abdominal pain. Computed Tomography (CT) imaging showed multiple intra-abdominal soft tissue masses in the greater omentum, anterior abdominal wall, and small bowel mesentery suspicious for intraabdominal malignancy. She underwent CT guided biopsy showed filamentous gram-positive bacteria concerning for actinomycetes but no malignant process. CASE DESCRIPTION/METHODS: An 88-year-old woman presented with abdominal pain, fatigue, and 15 lb weight loss over the past month. On admission, she was afebrile. Physical examination revealed mild tenderness over the left lower abdominal quadrant. Initial labs revealed hemoglobin of 8.5 g/dl, WBC of 26,500/mm3. CT of the abdomen identified multiple intra-abdominal masses in the greater omentum, anterior abdominal wall, and small bowel mesentery, with contained perforation of sigmoid diverticulitis. Due to the localized nature of the perforation, the patient was initially treated with antibiotics. However, given worsening symptoms and leukocytosis, the patient underwent CT-guided percutaneous aspiration of right and left omental mass. Histopathological examination showed no evidence of malignancy but an infection/inflammatory process. Tissue gram stain revealed filamentous organisms in the area suggestive for actinomyces colonies on H and E stain. The acid-fast stain was negative. Based on these findings, a diagnosis of abdominal actinomycosis was rendered. The patient was treated with IV ampicillin/sulbactam for 4 weeks followed by oral amoxicillin for 16 more weeks. On follow up, CT imaging showed significant interval improvement of the omental and anterior abdominal wall masses. DISCUSSION: The case reported by us of abdominal actinomycosis aims to highlight the malignancy- mimicking clinical and imaging features of this disease with the clinical symptoms of weight loss, fatigue, chronic lower abdominal pain, and the imaging findings of an intraabdominal mass(es), The diagnosis may be confounded by abdominal malignancy. A biopsy can help ascertain the diagnosis and further guide the management, as in our case. Actinomycosis can be treated with long term antibiotics and surgical debridement of the infected tissue. The prognosis is usually excellent in healthy patients, prompting the physicians to keep abdominal actinomycosis in the differential diagnoses of suspected abdominal malignancy.Figure 1.: CT scan with contrast showing 4.3 cm × 2.4 cm Well defined structure of the abdomen that shows peripheral enhancement and low attenuation centrally. Finding suspicious of Fluid collection.

Aspiration of sterile post-operative spinal fluid collections using low-dose computed tomography guidance

Sterile postoperative seromas can develop after posterior spinal surgery and cause pain, weakness, and numbness. Management typically involves operative evacuation. We propose that these collections can be managed with percutaneous computed tomography (CT) guided aspiration, potentially saving the patient an additional surgery. Here, we evaluate the safety and efficacy of this approach. Patients who developed symptomatic postoperative seromas within 60 days following surgery for spinal canal stenosis and had stable neurologic exams were considered for CT-guided percutaneous aspiration. To be considered for this approach, patients had to have pre-procedural evidence of radiographic spinal cord or cauda equina compression, hemodynamic stability, and low suspicion for infection. A total of 16 symptomatic collections were aspirated among 15 patients. The mean volume of fluid removed was 32.0 mL. There were no peri- or post-procedural complications. Eight (50%) had resolution or substantial improvement of their symptoms (p = 0.0002 when compared to the null hypothesis). One patient had short interval improvement but return of their initial symptoms 12 h following aspiration, 3/16 (19%) had minimal improvement, and 4/16 (25%) had no change in symptoms. Fluid collections that appeared denser on the pre-procedural CT were associated with retrieval of more sanguineous appearing fluid (p = 0.08). Neither the amount nor quality of fluid aspirated was associated with outcome. We conclude that percutaneous CT-guided aspiration of postoperative seromas is safe and should be considered as an alternative to open surgical evacuation in patients with stable neurologic exams.

Percutaneous computed tomography-guided lung biopsies: preliminary results using an augmented reality navigation system.

"Augmented reality" is a technique to create a composite view by augmenting the real intervention field, visualized by the doctor, with additional information coming from a virtual volume generated using computed tomography (CT), magnetic resonance or ultrasound images previously acquired from the same patient. In the present study we verified the accuracy and validated the clinical use of an augmented reality navigation system produced to perform percutaneous CT-guided lung biopsies. One hundred and eighty consecutive patients with solitary parenchymal lung lesions, enrolled using a nonrandom enrollment system, underwent percutaneous CT-guided aspiration and core biopsy using a traditional technique (group C, 90 patients) and navigation system assistance (group S, 90 patients). For each patient we recorded the largest lesion diameter, procedure time, overall number of CT scans, radiation dose, and complications. The entire experimental project was evaluated and approved by the local institutional review board (ethics committee). Each procedure was concluded successfully and a pathological diagnosis was reached in 96% of cases in group S and 90% of cases in group C. Procedure time, overall number of CT scans and incident x-ray radiation dose (CTDIvol) were significantly reduced in navigation system-assisted procedures (P <0.001; z = 5.64) compared with traditional CT-guided procedures. The percentage of procedural complications was 14% in group S and 17% in group C. The augmented reality navigation system used in this study was a highly safe, technically reliable and effective support tool in percutaneous CT-guided lung biopsy, allowing to shorten the procedure time and reduce the incident x-ray radiation dose to patients and the rate of insufficient specimens. Furthermore, it has the potential to increase the number of procedures executed in the allocated time without increasing the number of complications.

Percutaneous computed tomography-guided aspiration and biopsy of intrathoracic lesions: Results of 265 procedures.

Context:Percutaneous computed tomography (CT)-guided needle aspiration and biopsy technique have developed over time as a method for obtaining tissue specimen. Although this is a minimally invasive procedure, complications do occasionally occur.Aims:The aim of the study was to evaluate the diagnostic yield and complications of 265 percutaneous CT-guided aspiration and biopsy procedures performed on various intrathoracic lesions.Settings and Design:Data of percutaneous CT-guided aspiration and biopsy procedures of intrathoracic lesions performed over a 4 year period were retrospectively analyzed.Subjects and Methods:Procedure details, radiological images, and pathological and microbiological reports were retrieved from radiology records and hospital information system. Technical success, diagnostic yield, and complication rates were calculated.Results:Total 265 procedures were performed for lung (n = 179), mediastinum (n = 73), and pleural lesions (n = 13). Diagnostic yield for lung, mediastinal, and pleural lesions was 80.7%, 74.2, and 75%, respectively, for core biopsy specimens. Major complication was noted in only one procedure (0.4%). Minor complications were noted in 13.6% procedures which could be managed conservatively.Conclusions:Percutaneous CT-guided aspiration and biopsy procedures for intrathoracic lesions are reasonably safe with good diagnostic yield. Complications are infrequent and conservatively managed in most of the cases.

A Giant Liver Cyst Successfully Treated With Alcohol Sclerotherapy

Symptoms in polycystic liver disease are due to both the number and size of cysts; treatment is usually directed at the largest cyst. Simple percutaneous cyst aspiration is associated with a high recurrence rate. Alcohol sclerotherapy, laproscpic cyst deroofing and liver resection have been used to treat cysts ranging from 5-20 cm. We report the successful treatment of symptomatic giant liver cyst with alcohol sclerotherapy. A 44 year old otherwise healthy female was evaluated for a 2-day history of worsening epigastric abdominal pain and fullness. Laboratory investigations revealed normal liver enzymes and function and mild normocytic anemia. Abdominal ultrasound (US) and computed tomography (CT) scan showed multiple hepatic cysts with a dominant cyst measuring 27 cm in diameter. The dominant cyst was treated by a CT-guided percutaneous drainage followed by alcohol sclerotherapy. A total of 5.3 liters of dark brown fluid was aspirated and 50 ml of 98 % absolute alcohol was injected as sclerosing agent. Cystic fluid analysis was unremarkable and consistent with the diagnosis of polycystic liver disease. Abdominal pain and fullness immediately and completely resolved. The procedure was well tolerated without immediate complications. The liver enzymes remained stable within normal range along with synthetic function of the liver. To our knowledge this is the largest reported liver cyst that was safely and successfully treated with CT-guided percutaneous aspiration and alcohol sclerotherapy. This procedure should be considered before exploring more invasive and costly treatment options.

Percutaneous aspiration versus catheter drainage of liver abscess: A retrospective review.

A review of the effectiveness and outcomes in liver abscess drainage performed by different operators using percutaneous aspiration (PA) and catheter drainage (PCD), respectively, from 2008-2013 at Sir Charles Gairdner Hospital, a tertiary hospital in Australia. Forty-two patients (29 males and 13 females; aged between 28-93 years; median age of 67 years) with liver abscesses underwent either ultrasound or CT-guided PA (n=22) and PCD (n=20) in conjunction with appropriate antimicrobial therapy. A median of 18 Gauge needle and 10 French catheters were utilised. Nineteen (86.4 per cent) PA cases and 12 (60 per cent) PCD cases were successfully drained on a single attempt (p=0.08). More male patients (69 per cent) than females (31 per cent) were observed. Portal sepsis (42.9 per cent) was the most common cause identified. Fever (47.6 per cent) was the most frequent clinical presentation on admission. Thirty-two patients (76.2 per cent) had solitary abscesses with a right lobe (59.5 per cent) predilection. CRP was significantly raised. The PCD group observed a significantly larger abscess size (p=0.01). Klebsiella pneumoniae was the most common organism isolated in both pus (33.3 per cent) and blood cultures (11.9 per cent). Five procedure-related complications were noted, all in the PCD group. Thirty-day mortality was 2.4 per cent. No difference was observed in clinical and treatment outcomes in both groups. The null hypothesis that both PA and PCD are equally effective in the drainage of liver abscess cannot be rejected. Apart from PA being simpler and safer to perform, the higher incidence of indwelling catheter-associated complications suggests that a trial of PA should always be attempted first.

Contribution of CT scan and CT-guided aspiration in the management of retropharyngeal abscess in children based on a series of 18 cases

ObjectiveThis study was designed to analyse the contribution of CT scan to the management of retropharyngeal abscess in children and the place of CT-guided percutaneous aspiration as an alternative to surgical drainage. Materials and methodsRetrospective study including 18 children with a mean age of 38months [range: 5–67months] presenting with retropharyngeal infection between 2006 and 2011. All cases were initially assessed by contrast-enhanced CT scan of the neck. Clinical, radiological treatment and bacteriological data were collected. Radiological results were correlated with surgical and percutaneous aspiration findings (presence or absence of an abscess). ResultsThe initial CT scan detected 14 abscesses, 3 cases of non-suppurative lymphadenitis and one case of retropharyngeal oedema. One case of non-suppurative lymphadenitis progressed to abscess after failure of antibiotic therapy and was treated surgically. Surgical drainage revealed a purulent collection in 11 cases and no collection in 3 cases. Four CT-guided percutaneous aspirations were successfully performed. Three cases were treated by antibiotics alone (2 cases of lymphadenitis and 1 case of retropharyngeal oedema). Bacteriological examinations revealed the presence of Streptococcus pyogenes in 78.5% of cases. The positive predictive value of the initial CT scan was 78.8% in our series. ConclusionContrast-enhanced neck CT scan confirmed the diagnosis of retropharyngeal abscess and the indication for surgical drainage. It must be performed urgently, on admission. When it is decided to treat the patient with antibiotics alone, follow-up imaging should be performed in the absence of improvement 24 to 48hours after starting antibiotics. CT-guided percutaneous aspiration is both a diagnostic modality confirming abscess formation of an inflammatory lesion of the retropharyngeal space as well as a therapeutic tool, sometimes avoiding the need for surgical drainage.

Percutaneous CT-Guided Aspiration and Core Biopsy of Pulmonary Nodules Smaller Than 1 cm: Analysis of Outcomes of 305 Procedures From a Tertiary Referral Center

We conducted a retrospective analysis to evaluate the diagnostic outcomes of CT-guided aspiration and core biopsy of 305 pulmonary nodules measuring less than 1 cm. We determined the diagnostic yield of using CT-guided aspiration and core biopsy to analyze 305 lesions in 290 patients. Diagnostic performance was evaluated according to the biopsy method, including aspiration alone, core biopsy alone, and combination use, and the consistency of the nodule, including solid, partly solid ground-glass opacity (GGO), and pure GGO. Final diagnoses were established in 268 of the 305 lesions (87.9%). Nondiagnostic biopsy results were obtained for 27 of the 268 lesions (10.1%). The overall sensitivity, specificity, positive predictive value, and negative predictive value for the diagnosis of malignancy were 93.1% (148 of 159 lesions), 98.8% (81/82), 99.3% (148/149), and 88.0% (81/92), respectively; diagnostic accuracy was 95.0% (229/241). Using multivariate logistic regression analysis, we found that aspiration alone was a significant independent risk factor associated with diagnostic failure (odds ratio, 3.199; p = 0.001). The use of CT-guided aspiration and core biopsy resulted in a high diagnostic yield for pulmonary nodules smaller than 1 cm. The use of the aspiration method alone was an independent risk factor associated with diagnostic failure.

Image-Guided Percutaneous Aspiration and Gelfoam Treatment of Petrous Apex Cholesterol Granuloma: A New Theory and Method for Diagnosis and Treatment

Although diagnosis of cholesterol granulomas of the skull base can be straightforward with computed tomography (CT) and magnetic resonance imaging (MRI) appearance, treatment is controversial with various skull base approaches described in the literature. This report describes a 35-year-old man who presented with a symptomatic, enlarging cystic lesion in the left petrous apex and clivus that had imaging features of a cholesterol granuloma (cholesterol cyst). Due to a prior history of treated mediastinal germ cell tumor, pathologic confirmation of the lesion was requested. A CT-guided percutaneous aspiration revealed dark used motor oil-like fluid. Continued aspiration yielded a change in the character of the fluid to marrow red. Injection of contrast revealed no communication with cerebrospinal fluid. Gelfoam (Pfizer, New York, New York, USA) was subsequently injected percutaneously into the residual cavity. Histopathology showed no evidence of malignancy and follow-up MRI at 1 month, 3 months, 6 months, and 1 year demonstrated continued decrease in size and signal of the lesion.

Percutaneous Computed Tomography-Guided Lung Biopsies: Preliminary Results using an Augmented Reality Navigation System

"Augmented reality" is a technique to create a composite view by augmenting the real intervention field, visualized by the doctor, with additional information coming from a virtual volume generated using computed tomography (CT), magnetic resonance or ultrasound images previously acquired from the same patient. In the present study we verified the accuracy and validated the clinical use of an augmented reality navigation system produced to perform percutaneous CT-guided lung biopsies. One hundred and eighty consecutive patients with solitary parenchymal lung lesions, enrolled using a nonrandom enrollment system, underwent percutaneous CT-guided aspiration and core biopsy using a traditional technique (group C, 90 patients) and navigation system assistance (group S, 90 patients). For each patient we recorded the largest lesion diameter, procedure time, overall number of CT scans, radiation dose, and complications. The entire experimental project was evaluated and approved by the local institutional review board (ethics committee). Each procedure was concluded successfully and a pathological diagnosis was reached in 96% of cases in group S and 90% of cases in group C. Procedure time, overall number of CT scans and incident x-ray radiation dose (CTDIvol) were significantly reduced in navigation system-assisted procedures (P <0.001; z = 5.64) compared with traditional CT-guided procedures. The percentage of procedural complications was 14% in group S and 17% in group C. The augmented reality navigation system used in this study was a highly safe, technically reliable and effective support tool in percutaneous CT-guided lung biopsy, allowing to shorten the procedure time and reduce the incident x-ray radiation dose to patients and the rate of insufficient specimens. Furthermore, it has the potential to increase the number of procedures executed in the allocated time without increasing the number of complications.

Splenic abscess caused by MRSA developing in an infarcted area: case report and literature review

We report a case of a 41-year-old man with a splenic abscess caused by methicillin-resistant Staphylococcus aureus (MRSA). He had been treated with antimicrobials and corticosteroids for interstitial pneumonia caused by Mycoplasma pneumoniae and hemolytic anemia. He developed catheter-related (MRSA) bacteremia during his stay in the ICU and was treated with teicoplanin for 2weeks. After 4 weeks of outpatient follow-up, he was readmitted to the hospital with fever and pain in the left upper quadrant. A thoracoabdominal CT scan showed subcapsular collection in areas of splenic infarction that had been detected on his first admission. CT-guided percutaneous aspiration resulted in the isolation of MRSA. The patient was treated successfully with teicoplanin for 6weeks. Our aim in presenting this quite rare case is to highlight the tendency of infarcts that develop as a result of hemolytic attacks during systemic infections to be a focus of infection for nosocomial bacteremia.

CT-guided Percutaneous Large-needle Aspiration and Bleomycin Sclerotherapy for Bronchogenic Cyst: Report of Four Cases

Fine needle aspiration alone has been used as a treatment for bronchogenic cysts, but is subject to a high rate of recurrence. The purpose of this study was to review our experience with computed tomography (CT)-guided percutaneous large-needle aspiration and bleomycin sclerotherapy of bronchogenic cysts in four patients. Four patients with bronchogenic cysts at subcarinal (n = 1), paraspinal (n = 1), or intrapulmonary (n = 2) sites were treated at two medical centers with percutaneous transthoracic aspiration with a 17.5-gauge needle and sclerotherapy with use of bleomycin as the sclerosant agent. Clinical symptoms were seen in three of the four patients: recurrent cough in two and recurrent chest discomfort and palpitation in one. CT was used to guide the procedures. After sclerotherapy, the sizes of ablated cysts were followed by CT. At a median follow-up of 10 months (range, 6-14 months), all three patients with symptoms had symptomatic relief and all four patients showed a nearly complete regression of bronchogenic cyst on follow-up CT. No recurrence was encountered. Minor complications included a small asymptomatic pneumothorax at the end of the procedure in one patient and a mild fever (38.0 degrees C-38.5 degrees C) on the first day after sclerotherapy in one patient, which resolved spontaneously without treatment. No major complications occurred. CT-guided percutaneous treatment of bronchogenic cysts with large-needle aspiration and bleomycin sclerotherapy was safe and effective in this limited series. Further investigation of this technique is warranted.

Successful treatment of a symptomatic L5/S1 discal cyst by percutaneous CT-guided aspiration

Background:Discal cysts are a rare cause of lumbar radiculopathy. Benefits of percutaneous computed tomography (CT)-guided aspiration of the cyst include decreased rate of infection, avoidance of general anesthesia, and quicker recovery. However, since the publication of a case of cyst recurrence after CT-guided aspiration, few have utilized this potentially valuable technique.Case Description:We present a patient with a discal cyst arising from the L5/S1 disc causing right S1 radiculopathy. He underwent percutaneous CT-guided aspiration with substantial improvement in his radicular pain with 19 months of follow-up. His improvement was measured quantitatively using the Japanese Orthopedic Association scale: 6/15 pre-procedure, 15/15 post-procedure.Conclusion:Percutaneous CT-guided aspiration of discal cysts may be a valid initial treatment option for this condition. Patients who do not respond or who have a recurrence can subsequently be treated by surgical excision.

CT-guided aspiration of an anterior cruciate ligament ganglion cyst with mucoid degeneration: A case report

We report a symptomatic case of mucoid degeneration of the anterior cruciate ligament with a ganglion cyst that was treated successfully with percutaneous CT-guided aspiration.

Midterm Results of Percutaneous CT-Guided Aspiration of Symptomatic Lumbar Discal Cysts

Lumbar intervertebral discal cysts are rarely reported. To our knowledge, only 12 cases have been reported in the literature. The symptoms are indistinguishable from those of typical discal herniation. Our aim is to report the imaging characteristics, method of percutaneous CT-guided aspiration, and clinical outcome after management of lumbar intervertebral discal cysts. Percutaneous CT-guided aspiration is an effective method for the management of lumbar intervertebral discal cysts.

Postoperative annular pseudocyst: report of two cases with an unusual complication after microdiscectomy, and successful treatment by percutaneous aspiration and steroid injection

Background context After microdiscectomy for extruded disc fragments, patients may develop recurrent symptoms from numerous causes. Postoperative annular pseudocysts represent a unique entity not previously described in the medical literature. Purpose To report unique imaging findings in two patients who presented with recurrent radiculopathic symptoms after microdiscectomy. To report successful percutaneous aspiration and steroid injection in one of these cases. Study design/setting Report of two cases. Methods Two patients underwent preoperative imaging with noncontrast magnetic resonance imaging (MRI) and postoperative imaging with pre- and postcontrast MRI. One of these patients underwent therapeutic computed tomography (CT)-guided aspiration and injection. Results MRI demonstrated T2 hyperintense and enhancing collections, which conformed to the shape of the resected disc fragment and communicated with the disc annulus. One of these cases demonstrated enlargement over several months with worsening of symptoms. Aspiration of the lesion produced thick fluid. The patient experienced marked relief of symptoms after the aspiration and injection of steroid into the lesion. Conclusions The unique imaging findings in these patients represent a previously undescribed complication of microdiscectomy, which we have termed “postoperative annular pseudocyst.” We have successfully treated one case with CT-guided percutaneous aspiration and injection.