Image-guided percutaneous drainage of tuberculous iliopsoas and spondylodiskitic abscesses: midterm results.
OBJECTIVE
To evaluate midterm results of percutaneous drainage (PD) with image guidance in 21 patients with tuberculous iliopsoas abscesses with or without spondylodiskitis.


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.


CONCLUSIONS
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.
Dinç
Hasan
H
Department of Radiology, Karadeniz Technical University Faculty of Medicine, Farabi Hospital, 61080 Trabzon, Turkey. hdinc@meds.ktu.edu.tr
Ahmetoğlu
Ali
A
Baykal
Süleyman
S
Sari
Ahmet
A
Sayil
Ozgür
O
Gümele
Halit Reşit
HR
D000038:Abscess / Q000000981:diagnostic imaging / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000008:administration & dosage; D003131:Combined Modality Therapy; D004322:Drainage; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016659:Psoas Abscess / Q000000981:diagnostic imaging / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D025321:Surgery, Computer-Assisted; D014057:Tomography, X-Ray Computed; D014399:Tuberculosis, Spinal / Q000000981:diagnostic imaging / Q000601:surgery*
D000995:Antitubercular Agents