Percutaneous Aspiration Of Abscess Research Articles

Metronidazole-induced Cerebellar Neurotoxicity

Unintentional overuse of commonly prescribed medications can prove catastrophic. A 30-year-old man presented with difficulty in speaking and walking since 10 days. Examination revealed ataxic gait and bilateral cerebellar signs. During a recent admission for amoebic liver abscess, he was managed with the percutaneous aspiration of abscess and metronidazole which he continued for more than 2 weeks. During the current presentation, brain imaging showed confluent hypodensities in the bilateral dentate nucleus suggestive of metronidazole toxicity. Two weeks after discontinuation of the offending agent, the patient improved clinically with complete radiological resolution of lesions.

Ultrasound guided interventions in the diagnosis and management of hepatic lesions

Background:Space occupying lesions of the liver are frequently reported during imaging of the abdomen. Patients with these lesions may be symptomatic or asymptomatic. Most of these lesions have nonspecific imaging findings. Hepatic lesions can be inflammatory like abscesses, benign lesions like hemangiomas or malignant lesions like hepatocellular carcinoma. Guided interventions in the liver may be for diagnostic purposes like fine needle aspiration cytology or biopsy for focal lesions or for therapeutic purposes like fine needle aspiration cytology (FNAC) or catheter drainage for abscesses and collections. Aims and objectives: The aims of this study were 1) to conduct US guided biopsy in hepatic lesions and to evaluate the safety of procedures as well as quality and adequacy of specimens obtained. 2. To conduct US guided aspiration or catheter drainage of hepatic abscesses and to evaluate the clinical outcome. 3. The utility of these ultrasound guided interventions to laboratory procedures. Methods:The study is a hospital based observational study of ultrasound guided interventional procedures in patients with liver lesions (benign or malignant) for. The study includes patients both sexes with age ranging from 4 years to 80 years. The study period was for duration of 18 months from October 2018 to May 2019. The study includes two groups of patients, one with liver abscesses for drainage and other with focal or diffuse hepatic lesions for diagnostic biopsy or cytology under sonographic guidance referred from various departments Results:This study describes the safety of ultrasound guided interventions in patients with varying hepatic lesions, the quality and adequacy of specimens obtained in diagnostic biopsy and FNACs and the clinical out come in patients with hepatic abscess treated by percutaneous abscess aspiration. Ultrasound guided intervention was performed in 55 patients with varying hepatic lesions. 25 patients with clinical and imaging diagnosis of hepatic abscess were treated with needle aspiration (21) or by pig tail catheter drainage (4). The patients were followed up until were discharged with complete clinical cure. Out of 25 patients only one patient was not cured and he had multiple complications due to liver abscess per se. Rest of 24 patients were completely cured with hospital stay ranging between 3 to 7 days after the procedure. Diagnostic biopsy (18) and FNAC (11) were performed in 29 patients with clinical and imaging diagnosis of malignant hepatic lesions. Out of 11 ultrasound guided FNACs one was suboptimal due to inadequate sample. Repeat trucut needle biopsy in that patient yielded adequate sample with histopathological diagnosis of hepatocellular carcinoma. The diagnostic yield of ultrasound guided FNAC was 91%. Conclusions:Ultrasonography is choice of image guidance as it provides real time visualization of needle (and catheter) position and movement, cost effective and free of ionizing radiation. Sonographically guided liver biopsy with 18-20-gauge automated gun biopsy needles is a safe procedure in expert hands with low morbidity. Ultrasound guided diagnostic biopsy or cytology providesrequisite and decent quality specimen for histopathological examination

Clinical profile of liver abscess in a tertiary referral hospital

Background: Liver abscess poses a major diagnostic and therapeutic challenge and is life threatening if left untreated. Amoebic and Pyogenic liver abscess are the common types. The objective of the study is to assess the clinical profile of liver abscess in patients attending a tertiary referral hospitalMethods: This is a Prospective study carried out in a surgical wards of a tertiary referral hospital from May 2013 to April 2016.Results: Data analysed with percentages. Out of 99 cases (48.5%) were in the age group of 41-50 years. Majority of cases (97.9%) were males. Alcohol intake present in (61.7%) cases. Amoebic abscess was (95%) and pyogenic abscess were (5%). All had abdominal pain (100%). (51.5%) cases had abdominal distension and (57.6%) cases had fever. All (100%) had right hypochondrial pain and intercostal tenderness. (49.5%) cases presented with hepatomegaly. (70.7%) cases were right lobe abscess and (21.2%) cases were ruptured abscess at initial presentation. (91%) cases were amoebic and (9%) cases were pyogenic in etiology. (30.3%) cases were treated with single aspiration, (25.3%) cases by percutaneous catheter drainage, (22.2%) cases underwent laparotomy and drainage, (19.2%) cases were treated by multiple aspiration and (3%) cases by conservative managementConclusions: Liver abscess more common in males with alcohol intake history in age group of 41-50 years. 90% were amoebic and 10% were pyogenic. Commonest symptom was abdominal pain. Right hypochondrial and intercostal tenderness were common signs. Right lobe was commonly involved. Percutaneous aspiration of abscess with antiamoebics and antibiotics forms mainstay of treatment.

Percutaneous ultrasound-guided aspiration of brain abscess in an elderly male patient

A 75-year-old male patient reported to our hospital with continuous fever, disorientation, and frequent vomiting for 15 days. He had undergone right-sided fronto-temporo-parietal bone craniotomy for the right side subdural hematoma over right cerebral hemisphere convexity 2 months before in a corporate hospital. Postoperative period was uneventful. He was a known diabetic and hypertensive. Noncontrast computed tomography examination of head showed right frontal lobe hypodense lesion with perilesional edema. Contrast-enhanced magnetic resonance imaging of the brain revealed a large ring enhancing abscess within right frontal lobe. Ultrasound examination of the head over scalp through craniotomy bony defect showed the hypoechoic abscess about 2 cm below the skin. As the patient was in low condition, percutaneous aspiration of abscess under ultrasonography (USG) guidance was planned under short general anesthesia. The abscess was aspirated and sent for culture. Intravenous sensitive antibiotic was continued for 6 weeks. The patient's condition improved remarkable 3 days after the procedure. Follow-up imaging showed decrease size of abscess with residual air inside the abscess. The patient improved significantly on follow-up. Hence, cerebral abscess can be managed by USG-guided percutaneous aspiration and parenteral antibiotics.

Outcome of percutaneous continuous drainage of psoas abscess: A clinically guided technique.

Background:Percutaneous aspiration of abscesses under ultrasonography (USG) and computer tomography (CT) scan has been well described. With recurrence rate reported as high as 66%. The open drainage and percutaneous continuous drainage (PCD) has reduced the recurrence rate. The disadvantage of PCD under CT is radiation hazard and problems of asepsis. Hence a technique of clinically guided percutaneous continuous drainage of the psoas abscess without real-time imaging overcomes these problems. We describe clinically guided PCD of psoas abscess and its outcome.Materials and Methods:Twenty-nine patients with dorsolumbar spondylodiscitis without gross neural deficit with psoas abscess of size >5 cm were selected for PCD. It was done as a day care procedure under local anesthesia. Sequentially, aspiration followed by guide pin-guided trocar and catheter insertion was done without image guidance. Culture sensitivity was done and chemotherapy initiated and catheter kept till the drainage was <10 ml for 48 hours. Outcome assessment was done with relief of pain, successful abscess drainage and ODI (Oswestry Disability Index) score at 2 years.Results:PCD was successful in all cases. Back and radicular pain improved in all cases. Average procedure time was 24.30 minutes, drain output was 234.40 ml, and the drainage duration was 7.90 days. One patient required surgical stabilisation due to progression of the spondylodiscitis resulting in instability inspite of successful drainage of abscess. Problems with the procedure were noticed in six patients. Multiple attempts (n = 2), persistent discharge (n = 1) for 2 weeks, blocked catheter (n = 2) and catheter pull out (n = 1) occurred with no effect on the outcome. The average ODI score improved from 62.47 to 5.51 at 2 years.Conclusions:Clinically guided PCD is an efficient, safe and easy procedure in drainage of psoas abscess.

Computerized tomography (CT)-guided aspiration of abscesses: Outcome of therapy at a tertiary care hospital

To review the experience with percutaneous aspiration of abscesses at a general, tertiary care hospital from 2000 to 2005. Computerized medical records of 90 patients who underwent radiologically guided drainage of 92 fluid collections were reviewed for demographic data, co-morbid conditions, location, radiographic imaging characteristics and culture results and to determine the long-term outcome of the procedure. Sixty-seven of 92 (73%) abscesses were cured without the need for open surgical drainage; 44 were cured within 14 days, and 23 had delayed resolution requiring prolonged antibiotics and/or a second drainage. Of the abscesses 85% were drained using a catheter in situ, the remaining aspirated using a needle. Twenty-five (27%) of the 92 abscesses failed percutaneous drainage, requiring open surgical drainage or lead to sepsis and death. Neither co-morbid conditions nor the location of abscesses affected the outcome of drainage. Patients who had sterile cultures of aspirated material after receiving antibiotics prior to the procedure had a significantly higher cure rate than otherwise (P<0.05). Catheter drainage was associated with a significantly higher cure rate than was needle aspiration (P<0.05). Percutaneous drainage, along with appropriate antibiotics, is an effective approach to treat deep abscesses. Drainage, itself, is the major determinant of outcome, rather than the location, characteristics of the abscess or condition of the patient prior to the procedure.