Percutaneous Ultrasound-guided Needle Aspiration Research Articles

Safety and efficacy of percutaneous ultrasound-guided needle aspiration of liver abscesses in a resource-scarce environment: The experience of a private diagnostic service center in kaduna over an 8-year period

Background: Liver abscess is a condition found in both the developed and the developing countries (including Nigeria), which was normally treated with drugs alone. Refractory patients who were initially treated by open abdominal surgery are now successfully treated with minimally invasive approach from increased availability and access to ultrasound in low-resource settings where the burden of liver abscess is still significant. To our knowledge, not much data are available in our environment on a large series of patients with liver abscess managed solely with percutaneous needle aspiration under ultrasound guidance in combination with systemic and local abscess sac antibiotic treatment. We, therefore, report our experience in the management of liver abscess in Goshen Diagnostic Services, Kaduna, Nigeria (a private diagnostic center). Aim: The aim of this study was to describe our experience in the ultrasound-guided percutaneous management of liver abscesses over a period of 8 years in a private diagnostic center and to review the literature. Materials and Methods: This prospective study was conducted over an 8-year period at Goshen Diagnostic Services (a privately owned diagnostic outfit with only outpatient facility), Kaduna, Nigeria, from June 2012 to May 2020, involving 77 adult patients (62 male and 15 female) with liver abscess who were referred from various medical facilities within the city just for drainage purposes. Results: A total of 77 patients were eligible for the study consisting of 62 males and 15 females (male-to-female ratio of 4:1). Fifty-eight (75.3%) of them were referred from government/public hospitals, whereas 19 (24.7%) were from privately owned medical centers. Fifty-three (68.8%) patients were referred when still on admission in the various hospitals, whereas 24 (31.2%) came as outpatients. Twenty-eight percent of them required only a single aspiration, whereas 38.9% and 24.7% had to go for a second and third episode, respectively. The success rate was 100% after 6 months of follow-up. Conclusion: Liver abscess management used to be a surgical dilemma with substantial morbidity and mortality but has currently become minimally invasive. At present, morbidity and mortality have markedly diminished, with reduced cost to the patient. The direct infiltration of drugs into the abscess sac has improved the success rate.

CYSTIC ADVENTITIAL DISEASE OF THE POPLITEAL ARTERY

Cystic adventitial disease (CAD) is a rare cause of unilateral intermittent claudication of unknown aetiology, which is characterized by the formation of multiple mucin-filled cysts in the adventitial layer of the arterial wall resulting in obstruction to blood flow. The disease predominantly presents in young otherwise healthy males and most commonly affects the popliteal artery (85% of cases). CAD can be diagnosed by duplex ultrasound, magnetic resonance imaging, magnetic resonance angiography, or computed tomographic angiography. Surgery is the primary mode of treatment, including exarterectomy, or replacement of the affected vascular segment by venous or synthetic interposition graft. Alternatively, the cysts can be drained by percutaneous ultrasound-guided needle aspiration. We conducted a review of the literature on the aetiology, diagnosis and treatment of this uncommon condition and present the case report.

Outcome of ultrasound guided pigtail catheter drainage of liver abscesses a prospective study of 126 cases

Background: With the advances in the intervention radiological techniques the laparotomy for liver abscess has been taken over by the percutaneous ultrasound guided needle aspiration as well as percutaneous ultrasound guided pigtail catheter drainage. This study was undertaken at Govt. Medical College & Associated hospitals, Jammu to assess the outcome of this minimally invasive procedure for Liver abscess. Methods: 126 patients were subjected to pigtail catheter drainage after localization with ultrasonography using modified Seldinger’s technique. The pigtail catheters of 8-14 Fr size was were used. All the samples of pus were subjected to microscopy for EH trophozoites, Gram stain and for pus culture and sensitivity. Patient’s vitals were monitored for 24 hours. Daily estimation of volume, colour and consistency of the drainage fluid was recorded. Follow-up USG was done on average of 5th postoperative day to assess the shrinkage of cavity and the amount of residual fluid. Removal of catheter was decided based on; the amount of pus drained (<50 ml for three consecutive days); disappearance of symptoms & signs; and USG abdomen showing signs of resolution. Results: The age of the patients in this study ranged from the 21 years to 70 years with M: F ratio of 13.5: 1. Pain, fever, tender hepatomegaly & anaemia were common symptomatology. Right lobe abscess was seen in 74.60% (n=94) of patients. Solitary abscess was seen in 110 patients (87.3%). 66 patients (52.38%) had ALA, 18 patients PLA & 42 were having indeterminate liver abscess. Smaller size catheter specially 8-10 Fr invariably blocks. Common problems encountered were local pain or discomfort due to catheter, peri-tubal leak in few cases, and local wound infection. The average period of continuous catheter drainage was 7.2 days maximum being 26 days. Average duration of hospital stay was 2.45 days. Success rate of the procedure was 96.82% (n=122). 04 patients needed laparotomy. Conclusions: Advances in interventional radiology have influenced management of liver abscess. We in our series of 126 pts of liver abscess conclude that image guided percutaneous pigtail drainage of liver abscess is a safe, effective minimally invasive procedure with negligible morbidity and no mortality. High procedural success rate has almost replaced conventional laparotomy in uncomplicated liver abscess.

Comparison of percutaneous ultrasound guided needed aspiration and open surgical drainage in management of puerperal breast abscess

Background: The treatment of puerperal breast abscess is a clinical dilemma which ranges from conservative treatment to surgical intervention. A recently highlighted approach is drainage of pus by needle aspiration with ultrasound guidance under antibiotic cover. This approach had advantage of complete resolution without incision scar, less morbidity and will allow the patient to carry on breast feeding. Aims & Objective: The aim of this study is to compare the management of puerperal breast abscess by percutaneous ultrasound guided needle aspiration versus open surgical drainage with special attention to resolution and complications. Material and Methods: In this interventional study, 70 puerperal breast abscess cases were randomly divided and undergone either percutaneous ultrasound guided niddle aspiration (Group A) or open surgical drainage (Group B) and results were compared. Results: Failure rate for aspiration therapy was17.14% with 06 patients requiring conversion to open surgical drainage after aspiration and were excluded from study. The resolution time was less in aspiration group. Painful and cumbersome daily changes of dressing, mammry fistula in 3 patients with ugly scar were the main drawback of open surgical drainage as compared to aspiration. However, there was high failure rate of aspiration therapy in abscesses presenting later than 5 days (45.83%) and those with >5 cm size (55.55%) on ultrasonography. Conclusion: Percutaneous ultrasound guided needle aspiration has acceptable failure rate and is an effective alternative to open surgical drainage of puerperal breast abscess especially for those present early and of small size.

In Treatment of Popliteal Artery Cystic Adventitial Disease, Primary Bypass Graft not Always First Choice: Two Case Reports and a Review of the Literature

Cystic adventitial disease (CAD) is a rare cause of unilateral intermittent claudication of unknown aetiology, which is characterized by the formation of multiple mucin-filled cysts in the adventitial layer of the arterial wall resulting in obstruction to blood flow. The disease predominantly presents in young otherwise healthy males and most commonly affects the popliteal artery. CAD can be diagnosed by magnetic resonance imaging, computed tomographic angiography, or duplex ultrasound. Surgery is the primary mode of treatment, including exarterectomy, or replacement of the affected vascular segment by venous or synthetic interposition graft. Alternatively, the cysts can be drained by percutaneous ultrasound-guided needle aspiration. We provide a literature update on the aetiology and treatment of this uncommon condition and present two cases supporting patient tailored treatment without primary bypass grafting.

Management of Pelvic Lymphocysts by Ultrasound-Guided Aspiration and Minocycline Sclerotherapy

Objective: The purpose of this study was to describe our experience with ultrasound-guided aspiration of postoperative pelvic lymphocysts followed by intracavitary minocycline injection as sclerotherapy. Patients and Methods: From 1997 to 2003, patients who developed either symptomatic or persistent lymphocyst after pelvic lymphadenectomy for gynecological malignancy were recruited in this study. All of the lymphocysts were palpable and were further examined by ultrasonography. Percutaneous ultrasound-guided needle aspiration of the lymphocyst was performed and then immediately followed by a single-dose injection of minocycline into the collapsed cavity. Follow-up was conducted every 4 weeks with pelvic examination and ultrasonography. Results: Nineteen patients with a total of 21 pelvic lymphocysts underwent this procedure. The median size of the lymphocysts was 6 cm in diameter (range, 4–9 cm). Fifteen patients received 1 treatment, 3 received 2, and 1 patient with bilateral lymphocysts received 3 treatments. Complete resolution occurred in 14 patients (74%), and the other 5 patients (26%) had partial resolution with the volume of the lymphocyst decreasing at least 50%. For the 14 patients with complete resolution, the median time from treatment to disappearance of the lymphocyst was 3 months (range, 1–10 months), and none of them developed recurrence during the average follow-up period of 40 months (range, 2–62 months). No significant complication occurred with this procedure except for transient mild to moderate pelvic pain. Discussion: Minocycline sclerotherapy seems to be a simple and safe method with a satisfactory success rate in treating lymphocysts which develop after pelvic lymphadenectomy. It can be performed in an outpatient setting and can be repeated if necessary. This procedure may be considered as the initial treatment modality for patients suffering from symptomatic or persistent lymphocysts after radical gynecological surgery.

Ultrasound-guided needle aspiration of amoebic liver abscess

This prospective study was carried out on 200 patients with clinically, ultrasonographically and serologically confirmed amoebic liver abscess. The role of ultrasound-guided needle aspiration in addition to medications was evaluated compared to drug treatment alone. Both the groups were monitored clinically and sonographically for up to 6 months after diagnosis. The initial response (after 15 days) was better in the aspirated group (P < 0.05) but resolution of abscess after 6 months were similar. There was a more rapid clinical response in the aspirated group, particularly in those with larger (> 6 cm) abscesses and there were no complications. Percutaneous ultrasound-guided needle aspiration is a safe diagnostic and therapeutic approach which enhances clinical recovery, accelerates resolution, especially in large abscesses, and prevents complications.