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Choi, Shin, Park, Kim, Choi, Bae, Choi, Na, and Jeong: Effectiveness of Fluoroscopic and US - Guided Percutaneous Catheter Drainage for Iliopsoas Abscess through the Anterolateral Transabdominal Approach
Interventional Radiology
Original Article

Journal of the Korean Society of Radiology 2011; 64(2): 139-146.

Published online: 28 February 2011

DOI: https://doi.org/10.3348/jksr.2011.64.2.139

Effectiveness of Fluoroscopic and US - Guided Percutaneous Catheter Drainage for Iliopsoas Abscess through the Anterolateral Transabdominal Approach

Ho Cheol Choi, M.D., Tae-Beom Shin, M.D., Mee Jung Park, M.D., Ji-Eun Kim, M.D., Hye-Young Choi, M.D., Kyung Soo Bae, M.D., Dae Seob Choi, M.D., Jae Boem Na, M.D., Seong Hoon Jeong, M.D.

1Department of Radiology, Gyeongsang National University, College of Medicine, Jinju, Korea.

Address reprint requests to: Ho Cheol Choi, M.D., Department of Radiology, Gyeongsang National University Hospital 90 Chilam-dong, Jinju 660-702, Korea. Tel. 82-55-750-8202, Fax. 82-55-758-1568, jaro2@hanmail.net

Received 28 June 2010       Accepted 22 October 2010

Copyright © 2011 The Korean Society of Radiology

Abstract

Purpose

We evaluated the effectiveness of performing fluoroscopic and ultrasonography guided percutaneous catheter drainage (PCD) through the anterolateral transabdominal approach for treating iliopsoas abscess.

Materials and Methods

From January 2008 to December 2009, fluoroscopic and US-guided PCD through the anterolateral transabdominal approach was performed on sixteen iliopsoas abscesses of fourteen patients (7 males and 7 females; mean age: 63 years; age range: 30-87 years). Six abscesses were on the right side and ten abscesses were on the left side. The location of the abscesses were the psoas muscle (n=7), the iliacus muscle (n=7) and the iliopsoas muscle (n=2). All the procedures were performed under fluoroscopy and US guidance in the angiography room. The clinical findings before and after the procedure, the duration of catheter insertion and the procedure-related complications were evaluated.

Results

15 out of the 16 iliopsoas abscesses were effectively treated. The duration of catheter insertion was 5-27 days (mean: 14.6) days. No patient had significant complications during or after drainage. One patient died of uncontrolled diabetes complications and shock on the 9th day after percutaneous catheter drainage. One recurrence was noted 5 months after removal of the catheter. This patient underwent aspiration and antibiotic treatment for this lesion and the patient improved.

Conclusion

Fluoroscopic and US-guided PCD for iliopsoas abscess through the anterolateral transabdominal approach is an effective and safe procedure.

Keywords: Psoas Abscess, Drainage, Postural, Ultrasonography guidance

Figures and Tables

Fig. 1

A 74-years-old woman with low abdominal and back pain.

A-C. Axial and coronal CT scan shows both iliopsoas abscesses, right psoas abscess was septated.
D. Percutaneous drainage catheters were inserted in the both iliopsoas abscesses using anterolateral transabdominal approach.
E. Additional catheter was inserted in the right upper septated psoas abscess. Posterior approach was used in this procedure on prone position.
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Fig. 2

Schematic drawings of US-guided anterolateral transabdominal approach.

A. Left iliopsoas abscess was overlaid with small bowel.
B. Compression of left lateral abdomen by US probe translocate the overlaid small bowels medially, and then psoas abscess could be punctured by needle.
C, D. On the sagittal views, compression of lower abdomen by US probe could translocate the overlaid bowels to the upper side.
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Fig. 3

A 68-years-old man with low back pain.

A, B. Axial and coronal CT scan shows low density abscess in the left iliopsoas muscle and another low density abscess in right gluteus muscle.
C. Ultrasonography on the left lower lateral abdomen shows high echoic abscess in the left iliac muscles.
D. 22G Chiba needle was inserted into left iliopsoas abscess through left lower lateral abdomen.
E. Abscess cavity was partially outlined by contrast materials and guide wire was inserted in the abscess cavity.
F. 10.2F drainage catheter was inserted successfully.
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Fig. 4

A 46-years-old man with left flank pain.

A. CT scan shows mild swelling and poorly enhanced left kidney with perirenal fluid collections that suggested acute pyelonephritis.
B. CT scan of psoas muscle level shows low density abscess cavity at left iliopsoas muscle.
C. Fluroscopic image after PCD shows abscess cavity which is partially filled with contrast materials.
D. One month follow up CT scan shows complete resolution of previously noted left iliopsoas abscess.
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Table 1

Characteristics and Underlying Diseases of the Study Subjects and Cultured Microorganisms

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Note.─ DM = diabetes mellitus, ESRD = end stage renal disease, PMHx = past medical history, PI = present illness, OP = operation, APN = acute pyelonephritis, S.aureus = Staphylococcus aureus, MRSA = methicillin-resistant Staphylococcus aureus, K.pneumoniae = Klebsiella pneumoniae, V.streptococcus = Viridance streptococcus, E.coli = Escherichia.coli

Table 2

Duration of Drainage and Clinical Outcome

jksr-64-139-i002

Note.─ M = months, N = not recurred

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