CT-guided percutaneous drainage of lung abscesses: review of 40 cases.

PURPOSE: To evaluate the safety and effectiveness of CT-guided percutaneous drainage of lung abscesses considering success rate versus complications. METHODS: This retrospective study was carried out at Computed Tomography and Interventional Radiology Department of Sotiria Hospital, Athens, Greece, from 1/1/2007 to 1/1/2010. Forty patients with lung abscesses in which antibiotic therapy failed and were managed with CT-guided percutaneous drainage were included in the study. Catheter placement was carried out using Trocar technique in the majority of the cases. RESULTS: Lung abscess completely resolved with no residual cavity in thirty three patients. Seven patients had residual cavity and surgery was performed. Thus, the success rate of radiological drainage of the lung abscesses (33/40) was 83%. Five (13%) patients developed pneumothorax. Three developed moderate pneumothorax and chest-tube needed to be inserted and two patients developed mild pneumothorax which was managed with aspiration. These patients were kept under observation and followed-up by chest X-rays. No other complications and no mortality occurred during the procedure for all the forty patients. CONCLUSION: CT-guided percutaneous catheter drainage is a useful and safe procedure for the treatment of patients with lung abscesses who do not respond to medical therapy and should be considered a valuable alternative to open surgery.

CT-guided percutaneous drainage of infected collections due to gastric leak after sleeve gastrectomy for morbid obesity: initial experience.

This study was designed to evaluate the efficacy and safety of computed tomography (CT)-guided drainage in treating infected collections due to gastric leak after laparoscopic sleeve gastrectomy for morbid obesity. From January 2007 to June 2009, 21 patients (9 men and 12 women; mean age, 39.2 (range, 26-52) years) with infected collections due to gastric leak after laparoscopic sleeve gastrectomy for morbid obesity underwent image-guided percutaneous drainage. All procedures were performed using CT guidance and 8- to 12-Fr pigtail drainage catheters. Immediate technical success was achieved in all 21 infected collections. In 18 of 21 collections, we obtained progressive shrinkage of the collection with consequent clinical success (success rate 86%). In three cases, the abdominal fluid collection was not resolved, and the patients were reoperated. Among the 18 patients who avoided surgery, 2 needed replacement of the catheter due to obstruction. No major complications occurred during the procedure. The results of our study support that CT-guided percutaneous drainage is an effective and safe method to treat infected abdominal fluid collections due to gastric leak in patients who had previously underwent laparoscopic sleeve gastrectomy for morbid obesity. It may be considered both as a preparatory step for surgery and a valuable alternative to open surgery. Failure of the procedure does not, however, preclude a subsequent surgical operation.