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CT guided transthoracic catheter drainage of intrapulmonary abscess
1Department of Radiology, Al-Noor Hospital, Makkah, Saudi Arabia.
Insights
Computed tomography (CT)-guided percutaneous drainage is an effective treatment for lung abscesses, offering a lower complication rate than surgical resection. This minimally invasive procedure should be the primary choice for patients unresponsive to medical therapy.
Area of Science:
- Radiology
- Interventional Radiology
- Pulmonology
Background:
- Lung abscesses are potentially serious infections requiring effective treatment.
- Surgical resection has historically been used but carries significant morbidity.
- Percutaneous drainage offers a less invasive alternative.
Purpose of the Study:
- To evaluate the efficacy of CT-guided transthoracic catheter drainage for intrapulmonary abscess.
- To assess the success rate and complication profile of this procedure.
Main Methods:
- A prospective study involving 19 patients with lung abscesses.
- CT-guided percutaneous catheter placement using the Seldinger technique.
- Monitoring for complications and treatment outcomes.
Main Results:
- Eight patients (42.1%) had complete resolution without complications.
- Pneumothorax was the most common complication (26.3%), mostly mild and self-resolving.
- Two patients required surgery due to residual cavities (associated with CCAM) or bronchopleural fistula.
- No mortality was observed.
Conclusions:
- CT guidance ensures precise catheter placement for safe and effective lung abscess drainage.
- Percutaneous catheter drainage demonstrates lower morbidity and mortality compared to surgical resection.
- CT-guided drainage is recommended as a first-line therapy for medically refractory lung abscesses.
Objective:
To determine the efficacy of CT- guided transthoracic catheter drainage of intrapulmonary abscess considering success rate versus complications.
Methods:
This prospective study was carried out at radiology department of Al-Noor Specialist Hospital, Makkah, Saudi Arabia, from 1.1.2003 to 31.12.2005. Nineteen patients were selected for CT guided percutaneous drainage. Under CT guidance catheter placement was carried out using Seldinger technique.
Results:
Nineteen patients with lung abscess were selected for the percutaneous CT guided drainage. Eight (42.105%) patients encountered no complications and lung abscess completely resolved with no residual cavity. Five (26.31%) patients developed pneumothorax, which was the most common complication of this study. These patients were kept under observation and followed-up by chest X-rays. Three (15.78%) had mild pneumothorax, which resolved and needed no further management, while two (10.52%) patients developed moderate pneumothorax and chest tube was inserted. Two (10.52%) patients developed mild haemoptysis which resolved within two hours, hence, no further management was required. Two (10.52%) patients had residual cavity and surgery was performed. Congenital cystic adenomatoid malformation (CCAM) was found in both cases. Two patients out of nineteen patients (10.52%) developed bronchopleural fistula and were operated. No mortality occurred during or after the procedure.
Conclusion:
CT allows optimal placement of catheter and hence enables safe and effective percutaneous evacuation of lung abscess. The morbidity and mortality of patients with percutaneous catheter drainage is lower than with surgical resection. Hence, CT guided drainage should be considered the first therapeutic choice in most patients of lung abscess who do not respond to medical therapy.
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