Multiloculated Abscess Research Articles

Possible role of adjunctive thalidomide therapy in the resolution of a massive intracranial tuberculous abscess

We present the case of a young child who developed a massive tuberculous abscess of the posterior fossa while being treated for pulmonary tuberculosis. Clinical improvement after surgical excision of the abscess was followed by recurrence of symptoms of acutely raised intracranial pressure on standard antituberculosis and corticosteroid therapy. Magnetic resonance (MR) imaging of the brain showed that a multiloculated abscess had developed anterior to the excision site of the original abscess. The recurring abscess was partly excised and drained but could not be removed completely because of its proximity to the brain stem. Thalidomide, a potent inhibitor of tumour necrosis factor alpha (TNF-alpha), was added to the treatment regimen and resulted in marked clinical improvement with resolution of the abscess within 4 months. The remaining CT lesion had the appearance of a small granuloma. Both the clinical and the radiological response was maintained after 1 year of antituberculosis treatment.

An Unusual Case of Acquired Ventricular Septal Defect as a Complication of Aortic Valve Endocarditis: Echocardiographic Delineation of Multiple Subvalvular Complications in One Patient

We describe a patient with unusual echocardiographic features of prosthetic aortic valve endocarditis. Transesophageal echocardiography in this patient demonstrated a large multiloculated aortic root abscess extending to mitral-aortic intervalvular fibrosa, a high acquired ventricular septal defect, paravalvular aortic regurgitation caused by aortic valve dehiscence, and anterior mitral valve leaflet perforation. (J Am Soc Echo-cardiogr 2000;13:693-5.)

Adjuvant Urokinase Therapy in Percutaneous Drainage of a Multiloculated Splenic Abscess

Ian M. G. Kelly, MRCPI, FRCR SPLENIC abscess is an uncommon monthly Gold injections (intramusChristopher S. Boyd, BSc, condition that is usually associated cular sodium aurothiomalate) and FRCS with sepsis and immunosuppreshad intraarticular corticosteroid Peter T. Kennedy, FRCSI, sion, and may be drained safely and knee injections as recently as a FRCR effectively by percutaneous methods week before this presentation. She (1,2). However, the use of adjuncalso had an endometrial polyp (adetive intracavitary fibrinolysis in nofibroma) removed 6 weeks before

Visceral organ abscesses in melioidosis: sonographic findings.

We describe the sonographic appearances of extrapulmonary visceral organ abscesses in melioidosis and examine the role of sonography in early detection and follow-up of this elusive disease. The sonograms and records of 80 patients with melioidosis were retrospectively reviewed. The number, size, sonographic appearances, and distribution of abscesses in the abdominal visceral organs were analyzed. The most common suspected diagnoses upon hospital admission were septicemia and pyrexia of unknown origin (39%). Abdominal visceral organ abscess was suspected in only 28% of patients. Fifty-seven patients (71%) had single organ involvement, and 23 (29%) had multiple organ involvement. There were lesions in the spleen in 59 patients (74%), liver in 37 (46%), and kidney in 10 (12%). Multiple abscesses were much more common than a solitary abscess in each organ and were demonstrated in 83%, 68%, and 75% of patients with spleen, liver, and kidney involvement, respectively. The sonographic findings of multiple small abscesses with a "target-like" appearance and larger multiloculated abscesses were common in every organ. The findings of multiple small, discrete abscesses in visceral organs, particularly the spleen, should raise the suspicion of this disease. In endemic areas, screening sonography should be done in every patient presenting with septicemia or fever of unknown origin.

One-step needle aspiration and lavage for the treatment of abdominal and pelvic abscesses.

This retrospective study was undertaken to show the efficacy and safety of one-step needle aspiration and lavage for the treatment of nonenteric, nonpancreatic abdominal and pelvic abscesses. Eighty-two nonconsecutive patients (age range, 4-81 years old) with 97 abdominal and pelvic abscesses were treated over 16 years with a one-step percutaneous needle aspiration and lavage technique. Abscesses were drained with sonographic or CT guidance in a single session. An 18-gauge needle was used for aspiration and repeated saline lavage; no drainage catheter was left in place. For collections that appeared multiloculated, needle repositioning and repeated aspiration and lavage were performed during the single session. All patients received i.v. antibiotics. Eighty-seven (90%) of 97 abscesses in 72 of 82 patients were successfully treated, including 17 (85%) of 20 abscesses that were multiloculated. The only two complications were transient sepsis in one patient and hemorrhage in one patient that resolved with transfusion and conservative treatment. Needle aspiration and lavage failures were associated with diffuse peritonitis, occult malignancy, unsuspected enteric communication, and a dropped surgical clip. Percutaneous needle aspiration and lavage can be a safe, effective alternative to the more conventional treatment of prolonged catheter drainage. In selected patients, including certain patients with multiloculated abscesses, one-step needle aspiration and lavage should be considered as the initial method of treatment.

Ilio-psoas abscesses: Percutaneous drainage under image guidance

Over a 5-year period, 56 psoas abscesses occurring in 51 patients were managed by image-guided percutaneous drainage, either by needle aspiration (n = 10) or by catheter drainage (n = 46) in conjunction with medical therapy. Twenty-seven patients had tuberculous abscesses (bilateral in five) while 24 patients had pyogenic abscesses. Percutaneous treatment was successful in 16 of the 24 patients (66.7%) with pyogenic abscesses. The reasons for failure were co-existent bowel lesions, phlegmonous involvement of muscle without liquefaction, multiloculated abscess cavity and thick tenacious pus not amenable to percutaneous drainage. Surgery was required in seven patients, either for failed percutaneous drainage or for the management of co-existent disease. Percutaneous drainage was initially successful in all 27 patients of tuberculous psoas abscesses. However, eight patients presented with recurrence requiring repeat intervention. The average duration of catheter drainage was longer in patients with tuberculous abscess (11 days) than in patients with pyogenic abscess (6 days). Percutaneous drainage under image guidance provides an effective and safe alternative to more invasive surgical drainage in most patients with psoas abscesses.

Percutaneous catheter drainage of tuberculous and nontuberculous psoas abscesses

Objective: To assess the utility of percutaneous catheter drainage in the management of tuberculous and nontuberculous psoas abscesses associated without any bony involvement or with minimal bony lesions that could not cause vertebral instability. Materials and method: Eleven patients with psoas, iliopsoas and pelvic abscesses were drained under computed tomography and ultrasono-graphy guidance. Results: There were 15 (10 tuberculous, 5 pyogenic) abscesses in 11 patients. Six of the tuberculous abscesses and one of the pyogenic abscess were associated with vertebral involvement. Vertebral lesions were located in one or two vertebrae without causing any serious disturbance in the vertebral stabilization. In one case, the abscess was bilateral. Nine cases were drained under computed tomography guidance, while two cases were drained under both computed tomography and ultrasonography guidance. One session drainage was sufficient for abscess resolution in uniloculated cases. In the two of four multiloculated cases, catheter drainage was performed twice. Relapse of the abscess was found in only one patient. The mean abscess volume was 520 ml and mean drainage duration was 12 days. None of the cases required surgery. Conclusion: Percutaneous drainage, chemotherapy and additional external brace application with the cases associated with bony lesion may be used for treatment of tuberculous and nontuberculous unilocule and multiloculated abscesses.

Significant Role of Chemotherapy in the Treatment of Multiloculated Liver Abscesses Evaluated with CT and Angiographic Examinations

The role of chemotherapy was evaluated in 2 cases of solitary multiloculated liver abscesses. Both patients were free of biliary tract diseases, liver trauma, iatrogenic causes and colorectal diseases. Angiography revealed a hypervascular abscess wall and increased flow of the hepatic artery. In the first case, pyelonephritis was accompanied by left renalstones, and Escherichia coli was isolated from the urine. Since a laboratory examination revealed liver dysfunction, a CT was performed which disclosed a liver abscess. A percutaneous nephrostomy and chemotherapy were performed. Pus from the abscess yielded Streptococcus sanguis, along with unidentified gram-positive rods and anaerobic gram-negative cocci. The liver abscess did not resolve in spite of percutaneous drainage and administration of imipenem, which may have been due to the presence of multiple septa. After the administration of piperacillin, the body temperature normalized, and fistulography revealed adequate drainage of the liver abscess which subsequently resolved. In the other case, the patient had pyorrhea with an accompanying right subphrenic abscess. Fusobacterium sp. were recovered from the pus of liver abscess. Flomoxef was administered for 17 days prior to percutaneous drainage. Serial CT examinations revealed the disappearance of septa in the liver abscess cavity, and the patient made an uneventful recovery after percutaneous drainage. Piperacillin and flomoxef are excreted into bile fairly well in the absence of biliary obstruction, which may indicate that the high biliary concentrations of these antimicrobial agents is responsible for the elimination of multiple septa and the favorable response of multiloculated liver abscesses to percutaneous drainage.

Percutaneous debridement of complex pyogenic liver abscesses: technique and results

The author's approach and technique in the treatment of complex liver abscesses that persisted or recurred following percutaneous drainage are described. Six patients were treated by percutaneous de-bridement utilizing an instrument specifically constructed for that purpose. Four patients were chronically ill but stable. Two patients were septic, hypotensive and considered life threatened. All patients had primary pyogenic abscesses. Four had demonstrated mixed bacterial flora consisting of E. coli, Klebsiella, Proteus and gram-positive cocci and two were caused by E. coli only. In all cases a contrast-enhanced CT of the abdomen revealed multiloculated or septated abscesses containing large central debris and peripheral shell or halo of compromised hepatic parenchyma. Debridement was successful in all cases resulting in complete healing in 4–12 days. Follow-up for periods of between 1 and 4.5 years revealed no recurrences. Three cases of infected tumors of the liver were referred for treatment. CT findings in these cases demonstrated a well-developed external capsule and internal septations and the absence of a surrounding halo of compromised parenchyma distinguishes them from primary abscesses.

Acute inflammation of the breast — the role of breast ultrasound in diagnosis and management

Twenty female patients aged between 24 and 69 years were referred for breast ultrasound (US) examination between June 1989 and June 1990, with clinical suspicion of a breast abscess. Six were currently lactating. Initial US examination confirmed the presence of an abscess collection in nine out of 20 patients. Seven of these subsequently had surgical incision and drainage. Two settled on medical treatment. No abscess was detected on initial US examination in the remaining 11 patients who were treated conservatively with oral antibiotics. One patient, who had markedly dilated ducts on her initial US examination, remained symptomatic. Follow-up US demonstrated a small fluid collection, which within 7 days developed into a large multiloculated abscess requiring surgical drainage. We feel that US is very useful in accurately demonstrating the presence or absence of an abscess collection in the acutely inflamed breast.

Computed axial tomography in the early diagnosis of prostatic abscess

An extensive, multiloculated prostatic abscess due to Staphylococcus aureus developed in a patient with mycosis fungoides. The clinical symptoms and signs were largely masked by prior antibiotic therapy until after urethral instrumentations. Computed axial tomographic scanning of the pelvis confirmed the clinical diagnosis and demonstrated the resolution of the prostatic abscess following antibiotic therapy. This is the first reported case of a prostatic abscess diagnosed by computed axial tomographic scanning.

The Hawkins needle-guide system for percutaneous catheterization: 2. Clinical experience in biliary tract and abscess drainage.

In 1979, a new, 22 gauge needle guide was introduced for combined percutaneous transhepatic cholangiography and biliary drainage procedures. In 103 biliary procedures and 29 abscess drainages using this needle guide, there were no major complications. The use of a small-volume (1-2 ml), low-pressure contrast injection followed by 24 hr of external decompression using self-retaining catheters (Cope loop, accordion) has reduced sepsis as a problem in biliary procedures. Small targets (1-2 cm abscess cavities) can be safely searched for with this 22 gauge needle guide. Two multiloculated abscesses were successfully drained by applying the surgical principle of ingress-egress irrigation catheters for infected cavities.

Actinomycosis complicating Crohn's disease

A case of secondary infection of Crohn's disease by Actinomyces is reported. Clinically, Crohn's disease and actinomycosis may be difficult to differentiate. The distinguishing histopathological features of secondary actinomycosis include multiloculated abscesses, sulfur granules, typical organisms seen with Gram stain, and rarely, necrotizing granulomata. As actinomycosis may be cured by surgery and/or antibiotics, a careful search for Actinomyces including anaerobic culture is recommended in Crohn's disease with abscess formation.

Resection of Multiple Nocardial Brain Abscesses

We present a case of multiple brain lesions in which the preoperative computerized tomographic (CT) scan suggested the presence of brain abscesses rather than metastatic tumors. The patient presented with symptoms of left frontal and right cerebellar mass lesions, confirmed by carotid and vertebral arteriography and a radionuclide brain scan. A CT scan revealed multiple contiguous ring-enhancing lesions of various sizes at both sites. With the exception of a prior mild pulmonary infection, no findings suggested underlying malignancy, immunosuppression, or medical illness. We based our decision to administer antibiotics preoperatively on the presumed presence of abscess. We found and totally removed two multiloculated abscesses during one operation and initiated sulfa drug therapy (sulfisoxazole) immediately after identification of the Nocardia organism. The patient experienced no postoperative complications and at 6-months follow-up is clinically free of disease.

Experience with multiloculated brain abscesses.

The author reports his experience with 10 consecutive multiloculated brain abscesses diagnosed by computerized tomography and successfully treated by excision (primary or early secondary) or repeated aspiration.

The web factor in cholangitis

Choledochoscopy demonstrates that stone-related suppurative cholangitis has the pathologic characteristics of a multiloculated intraductal abscess. The fibrin web compartmentalizes the duct, traps calculi, and limits spontaneous extrusion. The stones act as foreign bodies and stasis maintains the bacterobilia. This is the anatomic basis and rationale for early direct surgical drainage as the definite effective treatment.

Bowel obstruction and perforation with an intraperitoneal loop intrauterine contraceptive device

Bleeding and lower abdominal pain were the presenting symptoms of a 26-year-old woman gravida 2 para 2 with a known extrauterine Lippes Loop. Kidney ureter and bladder X-ray examination showed an ectopic Lippes loop in the lower right quadrant with multiple distended loops of small bowel. Chest X-ray showed right lower lobe infiltrate. Treatment was instituted for infection and infiltrate. Diagnosis after 3 days was pelvic thrombophlebitis with septic embolization. At exploratory laparotomy a large multiloculated abdominal-pelvic abscess was found extending from the area of the ectopic Lippes Loop to the right upper quadrant and under the diaphragm. There was a transmural tear in the distal ileum at the IUD site through which a portion of the Lippes Loop extended into the bowel lumen. Bilateral tuboovarian abscesses were present. A subtotal hysterectomy bilateral salpingo-oophorectomy and layered closure of the small bowel tear were performed. This case indicates that in the presence of acute pelvic inflammatory disease any extrauterine IUD should be surgically removed.