Diagnostic ultrasound ( PDFDrive )

618 PART II Abdominal and Pelvic Sonography
B
A
FIG. 17.23 Renal Abscess Drainage. (A) CT scan with
orally administered contrast material shows a small (2.5 cm)
low-attenuating mass (arrows) in the middle of the left kidney.
(B) Longitudinal ultrasound of the left kidney shows a 2.5-cm
cystic mass with internal debris (arrows). (C) Transverse image
of the kidney (K). Using the Seldinger technique, a locking-loop
catheter (arrow) was placed into the renal abscess.
C
if such a communication exists. he cyst is then injected with
95% alcohol at half the cyst volume, not to exceed 100 mL. 167
Injection of lidocaine with the alcohol minimizes the burning
pain that oten accompanies alcohol i njection. he patient is
turned in various positions over a 20-minute period to facilitate
exposure of the cyst wall to the sclerosing agent. he alcohol is
aspirated and the drain removed or placed to continuous suction.
Repeat injections may be performed over the subsequent 2 to 3
days to maximize sclerosis. his technique is successful in more
than 95% of patients. 166,168 Although alcohol is the sclerosing
agent typically used, other agents include tetracycline, doxycycline,
talc, and iodine.
Liver Cyst
Similar to renal cysts, hepatic cysts can be efectively sclerosed
to provide long-term relief of symptoms. A communication to
the biliary tract is usually excluded by injecting the cyst with
contrast under luoroscopy. A smaller amount of alcohol (25%
cyst volume) has been proposed. 169 In one study, investigators
used alcohol and/or tetracycline or doxycycline in successfully
treating 85% of symptomatic hepatic cysts. 170
Ovarian Cyst
Historically, surgical extirpation of symptomatic ovarian cysts
has been the standard of care. Percutaneous management
has been discouraged because of the concern about seeding
malignant cells in the inadvertent aspiration of a low-grade
neoplasm and the poor sensitivity in characterizing aspirated
cyst luid. 171,172 However, given the well-recognized sonographic
criteria of benign ovarian cysts, the conidence level in percutaneous
aspiration of such symptomatic simple cysts has
improved.
Ultrasound-guided aspiration of symptomatic, benign ovarian
cysts is highly efective in alleviating patient symptoms. 173 A
thorough ultrasound examination should be performed initially
to fully characterize the symptomatic cyst. If the cyst can be
conidently characterized as benign with no worrisome features,
aspiration can be performed. Some recommend obtaining