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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).

View larger version (128K): [in a new window]   Figure 1a. Images in a 30-year-old woman with left intradiscal and iliopsoas abscess and spondylodiskitis. (a) Contrast-enhanced sagittal T1-weighted MR image (700/12) shows intradiskal (between L5 and S1), prevertebral, and anterior epidural abscess (arrowhead) with peripheral rim enhancement. (b) Contrast-enhanced coronal T1-weighted MR image (480/14) reveals a left iliopsoas abscess (arrowheads) with characteristic peripheral rim enhancement. (c) Transverse CT scan shows a 14-F pigtail catheter in the cavity of the left iliopsoas collection. (d) One year after PD, contrast-enhanced sagittal T1-weighted MR image (700/12) shows total resolution of the intradiskal and iliopsoas abscess, but there is slight enhancement at the end plates. Because the patient’s clinical and laboratory findings were completely normal for someone with tuberculosis, the contrast enhancement was not interpreted as indicative of active infection.

View larger version (143K): [in a new window]   Figure 1b. Images in a 30-year-old woman with left intradiscal and iliopsoas abscess and spondylodiskitis. (a) Contrast-enhanced sagittal T1-weighted MR image (700/12) shows intradiskal (between L5 and S1), prevertebral, and anterior epidural abscess (arrowhead) with peripheral rim enhancement. (b) Contrast-enhanced coronal T1-weighted MR image (480/14) reveals a left iliopsoas abscess (arrowheads) with characteristic peripheral rim enhancement. (c) Transverse CT scan shows a 14-F pigtail catheter in the cavity of the left iliopsoas collection. (d) One year after PD, contrast-enhanced sagittal T1-weighted MR image (700/12) shows total resolution of the intradiskal and iliopsoas abscess, but there is slight enhancement at the end plates. Because the patient’s clinical and laboratory findings were completely normal for someone with tuberculosis, the contrast enhancement was not interpreted as indicative of active infection.

View larger version (135K): [in a new window]   Figure 1c. Images in a 30-year-old woman with left intradiscal and iliopsoas abscess and spondylodiskitis. (a) Contrast-enhanced sagittal T1-weighted MR image (700/12) shows intradiskal (between L5 and S1), prevertebral, and anterior epidural abscess (arrowhead) with peripheral rim enhancement. (b) Contrast-enhanced coronal T1-weighted MR image (480/14) reveals a left iliopsoas abscess (arrowheads) with characteristic peripheral rim enhancement. (c) Transverse CT scan shows a 14-F pigtail catheter in the cavity of the left iliopsoas collection. (d) One year after PD, contrast-enhanced sagittal T1-weighted MR image (700/12) shows total resolution of the intradiskal and iliopsoas abscess, but there is slight enhancement at the end plates. Because the patient’s clinical and laboratory findings were completely normal for someone with tuberculosis, the contrast enhancement was not interpreted as indicative of active infection.

View larger version (131K): [in a new window]   Figure 1d. Images in a 30-year-old woman with left intradiscal and iliopsoas abscess and spondylodiskitis. (a) Contrast-enhanced sagittal T1-weighted MR image (700/12) shows intradiskal (between L5 and S1), prevertebral, and anterior epidural abscess (arrowhead) with peripheral rim enhancement. (b) Contrast-enhanced coronal T1-weighted MR image (480/14) reveals a left iliopsoas abscess (arrowheads) with characteristic peripheral rim enhancement. (c) Transverse CT scan shows a 14-F pigtail catheter in the cavity of the left iliopsoas collection. (d) One year after PD, contrast-enhanced sagittal T1-weighted MR image (700/12) shows total resolution of the intradiskal and iliopsoas abscess, but there is slight enhancement at the end plates. Because the patient’s clinical and laboratory findings were completely normal for someone with tuberculosis, the contrast enhancement was not interpreted as indicative of active infection.

View larger version (101K): [in a new window]   Figure 2a. Images in a 28-year-old man with bilateral iliopsoas abscesses and associated spondylodiskitis. (a) Contrast-enhanced transverse CT scan shows the characteristic low-attenuating, multiloculated collection of fluid (arrows) with peripheral rim enhancement. (b) Contrast-enhanced CT scan shows the 14-F vanSonnenberg drainage catheter, which has been inserted with a posterior approach. Because the abscess compartments had communications with each other, the collection was completely evacuated in one session of catheter drainage and did not recur. (c) Follow-up contrast-enhanced transverse CT scan obtained 1 year after PD shows complete healing of the bilateral iliopsoas abscesses.

View larger version (105K): [in a new window]   Figure 2b. Images in a 28-year-old man with bilateral iliopsoas abscesses and associated spondylodiskitis. (a) Contrast-enhanced transverse CT scan shows the characteristic low-attenuating, multiloculated collection of fluid (arrows) with peripheral rim enhancement. (b) Contrast-enhanced CT scan shows the 14-F vanSonnenberg drainage catheter, which has been inserted with a posterior approach. Because the abscess compartments had communications with each other, the collection was completely evacuated in one session of catheter drainage and did not recur. (c) Follow-up contrast-enhanced transverse CT scan obtained 1 year after PD shows complete healing of the bilateral iliopsoas abscesses.

View larger version (114K): [in a new window]   Figure 2c. Images in a 28-year-old man with bilateral iliopsoas abscesses and associated spondylodiskitis. (a) Contrast-enhanced transverse CT scan shows the characteristic low-attenuating, multiloculated collection of fluid (arrows) with peripheral rim enhancement. (b) Contrast-enhanced CT scan shows the 14-F vanSonnenberg drainage catheter, which has been inserted with a posterior approach. Because the abscess compartments had communications with each other, the collection was completely evacuated in one session of catheter drainage and did not recur. (c) Follow-up contrast-enhanced transverse CT scan obtained 1 year after PD shows complete healing of the bilateral iliopsoas abscesses.