Diagnostic ultrasound ( PDFDrive )

CHAPTER 17 Ultrasound-Guided Biopsy of Chest, Abdomen, and Pelvis 617
A
B
C
FIG. 17.22 Ultrasound-Guided Pancreatic Pseudocyst
Drainage. (A) Contrast-enhanced CT scan shows a large luid
collection pseudocyst (P) anterior and superior to the pancreas.
(B) Ultrasound image shows aspiration needle (arrow) in the
pseudocyst, which contains echogenic debris. (C) With the
catheter exchange technique, a locking-loop catheter was
placed into pancreatic pseudocyst for drainage.
Success of percutaneous pseudocyst drainage ranges from
70% to 100%. 158 Ultimate success is associated with the integrity
of the pancreatic duct. 161
Spleen
Splenic abscesses are uncommon, and in the past they were
oten managed surgically. However, with increasing experience
in percutaneous abscess management, image-guided drain
placement into select splenic abscesses has been successfully
performed in up to 100% of patients. 162-164 With smaller (≤3 cm)
infected splenic luid collections, a trial of aspiration may be
reasonable, with drain placement if reaccumulation of luid occurs.
More complex, multiloculated abscesses or deep-seated collections
should be managed surgically. he primary risk of spleen drainage
is bleeding. 99
Kidney
Most renal abscesses can be successfully managed with percutaneous
drainage combined with systemic antibiotics (Fig.
17.23). he size of the abscess should be considered when
determining the type of treatment. For abscesses smaller than
3 cm, antibiotics alone are typically suicient for treatment. 165
Success in the percutaneous drainage of larger abscesses
ranges from 70% to 90%, with better results in treating smaller
abscesses. 165
PERCUTANEOUS CYST
MANAGEMENT
Renal Cyst
Simple aspiration of large, symptomatic or obstructing renal
cysts is inefective in the long-term management of renal
cysts because of rapid reaccumulation of cyst luid within
the cavity. 166 his has led to interest in aspiration combined
with sclerosis to provide more permanent ablation of the cyst
(Fig. 17.24).
he procedure involves placing a 6- to 8-French drain into
the cyst with aspiration of the cyst luid. If the cyst’s true benign
nature is in doubt, the luid may be sent for cytology and other
chemical markers to conirm a serous nature of the luid. If there
is no evidence of malignancy, the cyst is then injected with contrast
material under luoroscopy to exclude a communication with
the urinary collecting system; sclerosis should not be performed