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Image-guided Percutaneous Drainage of Tuberculous Iliopsoas and Spondylodiskitic Abscesses: Midterm Results¹

Hasan Dinç, MD, Ali Ahmetolu, MD, Süleyman Baykal, MD, Ahmet Sari, MD, Özgür Sayil, MD and Halit Reit Gümele, MD

¹ From the Departments of Radiology (H.D., A.A., A.S., O.S., H.R.G.) and Neurosurgery (S.B.), Karadeniz Technical University Faculty of Medicine, Farabi Hospital, 61080 Trabzon, Turkey. Received August 28, 2001; revision requested October 17; final revision received April 8, 2002; accepted April 24. Address correspondence to H.D. (e-mail: hdinc@meds.ktu.edu.tr).

PURPOSE: To evaluate midterm results of percutaneous drainage (PD) with image guidance in 21 patients with tuberculous iliopsoas abscesses with or without spondylodiskitis.

MATERIALS AND METHODS: Computed tomography (CT)–guided PD was performed in 21 patients with 26 tuberculous iliopsoas abscesses. Nineteen patients had bone involvement of two or more vertebrae. Eleven patients with spondylodiskitis had intradiskal abscesses. Five patients had bilateral psoas abscesses. Easily and safely accessible well-circumscribed abscesses larger than 3 cm were selected for PD. Catheters were inserted into the abscess cavities with Seldinger technique in all cases. In conjunction with PD, all patients had antituberculous drug therapy and underwent clinical and imaging follow-up for at least 1 year.

RESULTS: Percutaneous catheter placement was successful in all cases without procedural complications. On the basis of CT findings, complete evacuation of all abscesses was achieved initially. During follow-up, six (29%) of 21 patients had recurrences within 1 and 3 months after catheter removal. A total of 37 catheters were used; eight of the 37 catheters were inserted due to recurrences. Four patients needed two PD procedures, and two patients needed three due to recurrences. Four catheters were changed because of obstruction or dislocation. Drainage duration ranged from 5 to 36 days (mean, 14.9 days). The follow-up period was 12–52 months (mean, 24 months). None of the patients, including those with recurrence, required surgical drainage and débridement due to insufficient PD.

CONCLUSION: Image-guided PD in conjunction with antituberculous drug therapy is an effective and safe procedure in the treatment of tuberculous iliopsoas abscesses with or without spondylodiskitis.

© RSNA, 2002

Index terms: Abscess, percutaneous drainage, 33.242, 33.1262 • Tuberculosis, musculoskeletal, 33.231

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