Percutaneous management of hepatic abscess: a perspective by interventional radiologists

Techniques for treating hepatic abscess have evolved rapidly during the past decade. For many years, the traditional treatment was surgical drainage. The development of modern imaging modalities, such as CT and US, has not only made the diagnosis more certain, but has also introduced a variety of percutaneous treatment options. Pyogenic hepatic abscess is now accepted as a medical/radiologic disease requiring surgical intervention only for correctable offending causes or for failed radiologic evacuation. Drainage via an indwelling catheter has been the traditional method of percutaneous treatment. However, indwelling catheters have disadvantages, including patient discomfort, the nuisance of catheter maintenance, and postprocedural complications. The technique of simple aspiration and intracavitary antibiotics as advocated by McFadzian et al, with excellent results confirmed by Giorgio et al, is a promising alternative to prolonged catheter drainage, and may be the biggest advancement in the management of hepatic abscess in 80 years. Surgeons have recently accepted radiologic drainage; now we need to see if interventional radiologists and surgeons will accept evacuation without indwelling catheter drainage. The role of interventional techniques for nonpyogenic hepatic abscesses will vary considerably. Mortality will still occur in the pyogenic varieties but should be related to underlying disease rather than the abscess itself.