(Radiology Review) Italian radiologists report that trial percutaneous needle aspiration of multiple pyogenic liver abscesses, under ultrasound guidance, should be performed prior to catheter drainage or surgery. Because of its low-cost, real-time nature, and mobility, ultrasound is more versatile than CT guidance, according to Dr. Antonio Giorgio and colleagues.
The authors noted that previous studies reported a significant mortality rate for multiple pyogenic liver abscesses (44% to 22.1%). This retrospective study, published in the American Journal of Roentgenology (December 2006, Vol. 187:6, pp. 1585-1590), is unique and meaningful because of the "large series of patients with multiple pyogenic liver abscesses managed only with percutaneous needle aspiration under sonographic guidance and with long-term follow-up," they wrote.
During a 13-year period, radiologists at Cotugno Hospital in Naples treated 39 patients with 118 pyogenic liver abscesses by performing 87 percutaneous needle aspirations. For consistency, all patients were treated with a single percutaneous needle aspiration of all abscess cavities in a single session, followed by broad-spectrum antibiotics.
For abscesses with a diameter less than 2 cm, a 22- or 20-gauge modified Chiba needle was used; for a diameter of 2-4 cm, a 20-gauge needle was used; and for abscesses larger than 4 cm, a 20- or 18-gauge needle was used. When a patient's fever persisted for three days after the procedure with no reduction in abscess size, repeat aspiration was performed.
"Complete reconstitution of liver parenchyma occurred within a maximum of 80 days" without abscess recurrence (mean follow-up period 18 months) or the need for percutaneous catheter or open surgical drainage, the authors reported.
Percutaneous needle aspiration of multiple pyogenic abscesses under sonographic guidance is a safe, effective, and low-cost procedure," the authors concluded. They recommended performing percutaneous needle aspiration with careful surveillance of fever and abscess size, before catheter drainage or surgery.
"Percutaneous Needle Aspiration of Multiple Pyogenic Abscesses of the Liver: 13-Year Single-Center Experience"
Antonio Giorgio et al
Giovanna Ferraioli, Interventional Ultrasound in Infectious Diseases Unit, D. Cotugno Hospital, Via Quagliariello 54, 80131 Naples, Italy
AJR 2006, December; 187:1585-1590
By Radiology Review
January 5, 2007
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