Image-guided catheter drainage of infected pleural effusions.
OBJECTIVE
To evaluate the safety and efficacy of image-guided drainage of infected pleural effusions.


METHODS
The clinical outcomes of 93 patients who underwent image-guided drainage of infected pleural effusions between 1998 and 2003 were retrospectively analyzed. Among the 93 patients, 31 (33.3%) were younger than 16 years of age. In all, 129 catheters (8F-14F pigtail catheters) were placed under ultrasonography (US) or computed tomography guidance. In 27 patients (29.0%) intracavitary fibrinolytic therapy with streptokinase was employed to improve drainage. The patients were followed up during daily rounds and, when drainage problems occurred, catheters were exchanged or repositioned. New catheters were placed for undrained loculations.


RESULTS
The success, failure, and recurrence rates were 92.5% (86/93), 7.5% (7/93), and 6.4% (6/93), respectively. In the pediatric age group the success rate was significantly higher. Intracavitary fibrinolytic therapy significantly improved daily output, but did not significantly reduce drainage duration or hospital stay. There was no significant difference between the successful and failed treatment cases in terms of US findings, gross appearance, or culture positivity. The only major complication was anaphylactic reaction due to intracavitary instillation of streptokinase (n = 1, 1.1%). The 30-day mortality rate was 2%.


CONCLUSIONS
Image-guided catheter drainage of infected pleural collections is a safe and effective method. Addition of intracavitary fibrinolytic instillation improves drainage, but early intervention prior to collections becoming more complicated remains an important factor in determining prognosis. Non-loculated anechoic collections without septa have a high probability of favorable outcome.
Akhan
Okan
O
Department of Radiology, Hacetttepe University School of Medicine, Ankara, Turkey. akhano@tr.net
Ozkan
Orhan
O
Akinci
Devrim
D
Hassan
Abdulla
A
Ozmen
Mustafa
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D004322:Drainage / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D007223:Infant; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy*; D015641:Radiography, Interventional / Q000379:methods / Q000706:statistics & numerical data*; D012008:Recurrence; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology; D014463:Ultrasonography / Q000706:statistics & numerical data
D005343:Fibrinolytic Agents