Ultrasound-guided Percutaneous Needle Aspiration Research Articles

Presentation, demography and management of Liver abscess patients in a tertiary care hospital of India

Background: Liver abscess (LA) is a cause of significant morbidity and requires timely management to prevent fatality. Aim: To study the demographic features, clinical presentations, and outcomes of liver abscess in Northern India. Material and methods: A prospective observational study was conducted on consecutive liver abscess patients presenting to a tertiary care centre treated from August 1, 2017, to 31, December 2020. The study participants were followed up for a period of one year Demographic features, clinical presentation and outcome were recorded and analyzed. Results: There were 83 males and 4 females, with mean age of 39.67 ± 11.85 years (ranging 13 to 70 years). History of alcohol intake was present in 85% (74/87) patients. The presenting symptoms were right upper abdominal pain in 91.95% (80/87), fever in 87.36% (76/87), nausea and/or vomiting 82.76% (72/87) and jaundice in 10.34% (9/87) cases. The commonest identifiable cause was colitis (11.5%). Majority of cases had a single abscess with involvement of right lobe of the liver. Out of 87 patients, 21 were cured with medical management and 56 additionally with ultrasound-guided percutaneous needle aspiration and drainage. Open drainage was performed 10 patients, of which 4 died. Conclusion: Early diagnosis and prompt institution of appropriate therapy is imperative in the management of liver abscess. Open drainage should not be delayed in cases lacking response to conservative treatment.

Prospective randomized comparison of ultrasound-guided percutaneous needle aspiration with percutaneous catheter drainage of liver abscesses

Background and Aims: Modern treatment of liver abscesses comprises combination of antibiotics and image-guided percutaneous needle aspiration (PNA) or percutaneous catheter drainage (PCD). However, there is debate regarding the choice of these interventions as the first line of management. Our aim was to compare the results of ultrasound-guided PCD with PNA in the management of liver abscesses. Materials and Methods: A total of 66 patients (55 males; 11 females, 18–65 years) who were diagnosed with liver abscesses were randomly divided into two groups of 33 patients each, namely ultrasound-guided PNA group (with a maximum of three attempts) and the PCD group. The outcomes of the treatment of the patients of these groups were documented and analyzed. Results: PNA was effective in 20 (61%) of the 33 patients after one (n = 14), two (n = 4), or three (n = 2) aspirations while PCD was therapeutic in all 33 patients after one (n = 29) or two (n = 4) procedures and without any major complications in both groups. All abscesses 45 mm or less in longest dimension were efficaciously managed, by both PCD as well as PNA while the later failed in case of multiloculated abscesses. The mean duration of intravenous antibiotics and time to clinical relief were significantly lesser in the PCD group. However, a period of hospital stay and time to complete resolution of abscess cavities did not differ significantly between the groups. Conclusions: Overall, PCD is more effective than PNA in the management of liver abscesses; the later, however, can be employed for smaller and simple abscesses.

Diagnosis and surgical treatment of patients with femoral vein compression from hip joint synovial cyst

ObjectiveIn this study, the diagnosis and treatment of patients with femoral vein compression from a synovial cyst of the hip joint were investigated. MethodsA retrospective study was conducted to review hospital records from March 2010 to July 2017 of patients with femoral vein compression from a synovial cyst of the hip joint. The diagnostic procedure, duplex ultrasound results, computed tomography (CT), and magnetic resonance imaging (MRI) were recorded. The method and treatment outcomes were also documented. ResultsFifteen patients with femoral vein compression resulting from a synovial cyst of the hip joint were identified. The mean age was 47.5 years, and nine of the patients (60%) were female. All patients had unilateral lower extremity edema. In 11 patients (73.3%), the mass in the groin area could not be palpated; 2 (13.3%) patients had venous insufficiency; and 2 (13.3%) patients had venous thrombosis. All patients received a duplex ultrasound examination, 4 (26.7%) patients received CT, and 11 (73.3%) patients received MRI. One patient received a duplex ultrasound-guided percutaneous needle aspiration; however, the cyst recurred 1 month later. The remaining 14 patients received surgical excision and had no cyst recurrence during the follow-up period (mean, 22.6 months). ConclusionsDuplex ultrasound should be selected as the first choice for screening of synovial cyst of the hip joint with femoral vein compression. Moreover, it can be used as the first choice for follow-up of these patients. MRI or CT can provide more anatomic information for surgical treatment. Surgical excision of the cyst is the preferred treatment method, with a lower rate of cyst recurrence compared with needle aspiration.

A Case of Cystic Adventitial Disease of the Popliteal Artery Successfully Treated by Ultrasound-guided Percutaneous Needle Aspiration

A Case of Cystic Adventitial Disease of the Popliteal Artery Successfully Treated by Ultrasound-guided Percutaneous Needle Aspiration

Ultrasound-guided Percutaneous Needle Aspiration by Pulmonologists: A Study of Factors With Impact on Procedural Yield and Complications.

The availability of portable ultrasound (US) guidance has led to usage by subspecialists outside of radiology. Several subspecialties now perform percutaneous fine-needle aspiration (PFNA) for lesions relevant to their expertise. This is a study of US-guided PFNA performed by interventional pulmonologists at a single institution. We retrospectively reviewed serial US-guided PFNAs performed at an institution with the goals of defining yield, factors relating to yield, and complication rates. A total of 111 consecutive lesions were evaluated and 109 biopsied during the study period. Diagnosis was established in 81% of cases (90/109), with a total complication rate of 15% but only 1 case of a need for a higher level of care. Factors associated with increased diagnostic yield were suspicion of malignancy, increased size, and pleural adhesions (lack of pleural sliding). The presence of pleural sliding was associated with increased pneumothorax and decreased yield. US-guided PFNA is a valuable tool for the interventional pulmonologist. Both size and pleural sliding have an impact on diagnostic yield.

Gigant Laryngocele Airway Management

A 69 years-old male presented at the emergency room with hoarseness, fever and a right-sided cervical mass. He had a previous history significant for cigarette smoking and chronic obstructive pulmonary disease. He used to be a glass-blower. The mass was already detected 10 years ago, but the patient neglected medical care at that point in time. It was noticed to suddenly increase its size over the last 15 days. He was admitted to the ward for observation. The computed tomography scan revealed a gigantic cyst (9.5 cm lateral x 7 cm anterior-posterior diameters) of air-density in close relation to the Morgagni ventricle, placed in the anatomic cervical areas II and III. It displaced the submaxilar gland anteriorly, the sterno-cleidomastoid muscle and carotid artery posteriorly and, very significantly, displaced laterally the larynx lumen, epiglottis and hyoid bone. The diagnosis was made for a giant laryngocele. Three days later the patient complained about sudden respiratory difficulty, cervical pain and difficulty to swallow. Thirty mL of air were obtained by ultrasound-guided percutaneous needle aspiration and a drain was left in place to avoid refilling of the space. The clinical picture improved significantly. He was scheduled for surgery ten days later. Direct endotracheal intubation was achieved at its first attempt, although with moderate difficulty due to having a Cormack-Lehane grade III, but no significant lateral displacement was noticed. A tracheostomy and cyst excision under general anesthesia was completed afterwards without problems.

Percutaneous management of pancreatic abscesses: Long term results in a single center

Background Several authors consider that surgical intervention is the gold standard for treatment of pancreatic abscesses. Recently, considerable interest has been generated in the minimally invasive management of pancreatic abscess with mixed results reported in the literature. Aim To evaluate the efficacy of percutaneous aspiration and/or drainage for patients with pancreatic abscesses. Methods We performed a retrospective analysis of 62 patients with 87 pancreatic abscesses treated by percutaneous management from 1989 to 2009. All patients received appropriate antibiotic therapy. Patients with pancreatic abscess < 50 mm in diameter were initially treated by ultrasound-guided percutaneous needle aspiration (PNA) and those with abscess ≥ 50 mm were initially treated by ultrasound-guided percutaneous catheter drainage (PCD). Surgery was planned only when there was no clinical improvement after the initial percutaneous treatment. Primary outcome was conversion rate to surgery. Results Two patients (3.2%) received supportive treatment only and one of them died. PNA was performed in 16 patients (25.8%), and 8 of them required PCD because of recurrence of abscess. In 44 patients (70.1%), PCD was performed initially. PCD was performed twice in 6 patients and 3 times in 2 patients. There were 5 patients converted to surgery (8.1%) and one of them died. Medians (interquartile ranges) of hospital stay and catheter dwell-time were 17 (12–26) and 12 (9–21) days, respectively. There were no complications related to the procedure. Conclusions Percutaneous aspiration and/or drainage are effective and safe for the treatment of pancreatic abscesses.

Rotator cuff calcifications: treatment with ultrasound-guided percutaneous needle aspiration and lavage.

To analyze the results of ultrasound (US)-guided needle puncture, aspiration and lavage in the treatment of symptomatic calcific tendinitis of the rotator cuff. Atraumatic pain in 61 shoulders of 58 patients was resistant to conservative therapy. The average age of the treated patients was 42 years (range 26-49 years), follow-up was 12 months, and the mean diameter of the calcifications was 1.6 cm (range 1.1-2.9 cm). With US guidance and local anesthesia, two needles were placed within each calcification. The calcification was punctured 10-15 times and saline solution injected and aspirated using the needles until the aspirate was free of calcific particles. Based on radiographs at 1 year follow-up. 74% (45 of 61) of the calcifications decreased, including 28% (17 of 61) which disappeared totally, and 26% (16 of 61) were unchanged. Calcifications with a faint or absent shadow on US proved to be nearly liquid (slurry calcification in 93% (14 of 15) of cases and could be aspirated. Clinical results were excellent in 74% (45 of 61), moderate in 16% (10 of 61) and poor in 10% (6 of 61) of cases. US offers technical advantages over fluoroscopy, and the typical US image of a slurry calcification helps to select the most suitable patients for aspiration treatment. The results are comparable with those using fluoroscopic guidance.

Bilomas: a new approach to the diagnosis and treatment.

Biloma, a newly described entity, appears to have gained a heightened clinical interest recently. During the past 18 months we have diagnosed 9 abnormal biliary collections. We discuss here the role of sonography and radionuclide cholescintigraphy in the evaluation of bilomas. The diagnosis of all cases was confirmed by ultrasound-guided percutaneous needle aspiration. Subsequently 7 patients were treated with catheter drainage, obviating the need for any surgery.