The value of computed tomography and ultrasound guided needle aspiration in suspected thoraco-abdominal abscess

The purpose of this study is to evaluate retrospectively the usefulness of computed tomography (CT) and/or ultrasound (US) guided interventions in patients with suspected thoracic/abdominal sepsis. Between January 2000 and May 2002, 135 patients [mean age 37 years (range 9-78)] underwent CT (GE Light Speed QX1 Helical CT) and for ultrasound (GE Logic 700) guided puncture, aspiration and drainage involving a mostly one-step Trocar and Seldinger technique. Most interventions were within the abdominal cavity and yielded fluid collections pyogenic in nature. Periappendicular abscesses were treated in 24 patients. There were 35 patients with suspected liver abscesses, two being found to consist of sterile haemtoma. In 11 patients abscesses were confirmed to be amoebic in origin. Percutaneous cholecystostomy was performed in 16 patients. Pleurocentesis was carried out in 21 patients with different pyogenic infections; in 4 patients tuberculosis (TB) was identified. In addition, TB was diagnosed in two of 8 patients with psoas abscesses. In 10 patients with septicaemia, considered to be at high surgical risk, our intervention was believed to be life saving. No serious complications were observed (two patients required additional analgesia for severe pain following percutaneous cholecystostomy). CT guided interventions were especially suitable in complicated abscesses, allowing 2 and 3D, and other suitable projections for an optimal approach.