Bedside drainage of abscesses with sonographic guidance in the desperately ill

Crass,; Karl, Richard C.

doi:10.2214/ajr.139.1.183

Cited by 24 publications

(24 citation statements)

References 6 publications

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“…Although a discussion of the optimal therapy for various ganglion and synovial cysts is beyond the scope of this review, there is some evidence to support the use of guided aspiration prior to or in lieu of surgical therapy [44] . For infectious indications, the use of ultrasound for both diagnostic and therapeutic purposes is also well described [45][46][47][48][49][50][51][52] . Ultrasound-guided aspiration or drainage catheter insertion has been successfully used to obtain fluid samples for microbial cultures as well as therapeutic drainage of collections [46][47][48][49][50][51] .…”

Section: Fluid Collection Aspiration and Drainage Catheter Insertionmentioning

confidence: 99%

“…For infectious indications, the use of ultrasound for both diagnostic and therapeutic purposes is also well described [45][46][47][48][49][50][51][52] . Ultrasound-guided aspiration or drainage catheter insertion has been successfully used to obtain fluid samples for microbial cultures as well as therapeutic drainage of collections [46][47][48][49][50][51] . There is also evidence supporing the use of ultrasound-guided techniques in the critically ill where transporting patients between different hospital locations may be either dangerous or not at all feasible [50] .…”

Section: Fluid Collection Aspiration and Drainage Catheter Insertionmentioning

confidence: 99%

“…Ultrasound-guided aspiration or drainage catheter insertion has been successfully used to obtain fluid samples for microbial cultures as well as therapeutic drainage of collections [46][47][48][49][50][51] . There is also evidence supporing the use of ultrasound-guided techniques in the critically ill where transporting patients between different hospital locations may be either dangerous or not at all feasible [50] . In the case of multiple abscesses requiring drainage, the use of ultrasound guidance is further supported due to the ability to manipulate the probe rather than the patient, as well as the avoidance of excessive/additional exposure to ionizing radiation seen with CT-guidance [48] .…”

Section: Fluid Collection Aspiration and Drainage Catheter Insertionmentioning

confidence: 99%

“…If there is evidence of purulence or other signs of infection, then the placement of a drainage catheter should be considered. This involves the use of a larger needle with a guide-wire being inserted through the needle into the fluid space [50] . After removing the needle with the guide-wire left in place, a dilator is placed over the guide-wire and the insertion site is expanded to accommodate an appropriately-sized catheter [50] .…”

Section: Fluid Collection Aspiration and Drainage Catheter Insertionmentioning

confidence: 99%

“…This involves the use of a larger needle with a guide-wire being inserted through the needle into the fluid space [50] . After removing the needle with the guide-wire left in place, a dilator is placed over the guide-wire and the insertion site is expanded to accommodate an appropriately-sized catheter [50] . The catheter is then inserted over the guide-wire and placement of the catheter within the fluid collection confirmed by direct vizualisation.…”

Section: Fluid Collection Aspiration and Drainage Catheter Insertionmentioning

confidence: 99%

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Ultrasound-assisted musculoskeletal procedures: A practical overview of current literature

Royall¹

2011

WJO

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Traditionally performed by a small group of highly trained specialists, bedside sonographic procedures involving the musculoskeletal system are often delayed despite the critical need for timely diagnosis and treatment. Due to this limitation, a need evolved for more portability and accessibility to allow performance of emergent musculoskeletal procedures by adequately trained non-radiology personnel. The emergence of ultrasound-assisted bedside techniques and increased availability of portable sonography provided such an opportunity in select clinical scenarios. This review summarizes the current literature describing common ultrasound-based musculoskeletal procedures. In-depth discussion of each ultrasound procedure including pertinent technical details, indications and contraindications is provided. Despite the limited amount of prospective, randomized data in this area, a substantial body of observational and retrospective evidence suggests potential benefits from the use of musculoskeletal bedside sonography.

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Section: Fluid Collection Aspiration and Drainage Catheter Insertionmentioning

confidence: 99%

Section: Fluid Collection Aspiration and Drainage Catheter Insertionmentioning

confidence: 99%

Section: Fluid Collection Aspiration and Drainage Catheter Insertionmentioning

confidence: 99%

Section: Fluid Collection Aspiration and Drainage Catheter Insertionmentioning

confidence: 99%

Section: Fluid Collection Aspiration and Drainage Catheter Insertionmentioning

confidence: 99%

See 3 more Smart Citations

Ultrasound-assisted musculoskeletal procedures: A practical overview of current literature

Royall¹

2011

WJO

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Ultrasound guided manual lysis of abscess loculations

Smith

Annesley

1985

J of Clinical Ultrasound

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Sonography is sensitive in detecting abdominal and pelvic fluid and it has been used to guide percutaneous needle a~p i r a t i o n~'~ and percutaneous catheter drainage of abscesses.6 - 8 We describe an unusual case where sonography was used to guide manual lysis of pelvic abscess loculations following radical cystectomy. CASE REPORTA 47-year-old woman with a remote history of total abdominal hysterectomy and radiation therapy for carcinoma of the cervix was admitted with weight loss, anorexia, and progressive suprapubic and right flank pain. Intravenous pyelography demonstrated a large filling defect in the right side of the bladder and nonfunction of the right kidney. Computed tomography showed a large mass involving the right lateral and posterior walls of the bladder with extension into the perivesical tissue and obstruction of the right ureter. Cystoscopy and transurethral biopsy revealed grade four transitional cell carcinoma of the bladder with muscle invasion, and the patient underwent radical cystectomy and right nephroureterectomy with anterior vaginectomy and ileal conduit urinary diversion. In the postoperative period, she was intermittently febrile, and sonography demonstrated a suprapubic fluid collection. On the fourteenth postoperative day, purulent pelvic fluid spontaneously drained vaginally via the dehisced anterior vaginectomy wound. Six days later, repeat sonography showed a large septated suprapubic pelvic fluid collection (Fig. 1 350tomography confirmed the presence of a large gas-containing pelvic fluid collection (Fig. 2) which was felt to represent an abscess. Sonographically guided percutaneous thin needle aspiration yielded small amounts of pus. Repeat manual pelvic exam by the surgeon with unguided attempt at lysis of the abscess loculations was again unsuccessful. Pelvic examination was then performed while the abscess fluid and septations were imaged with real-time ultrasound from a suprapubic approach. The pelvis was manually explored via the vaginectomy defect until the septations were seen moving by realtime sonography. Vigorous digital lysis of adhesions yielded copious amounts of pus per vagina. The procedure was repeated twice, each time using real-time sonography to localize residual pelvic fluid and confirm correct hand placement for manual lysis of adhesions. A Foley catheter was placed in the abscess cavity via the vaginectomy wound to promote further drainage.

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