title: Computed tomography-guided drainage of mediastinal abscesses: clinical experience with 23 patients.
abstract: OBJECTIVE
  To evaluate the technical and clinical success rates of computed tomography (CT)-guided percutaneous drainage of mediastinal abscesses.
  
  
  METHODS
  An interventional radiology database was used to identify patients who underwent CT-guided percutaneous drainage of mediastinal abscesses. Medical records were reviewed to evaluate abscess etiology, drainage technique, clinical outcome, and complications.
  
  
  RESULTS
  Over a 10-year period, 23 patients (20 men; average age, 54 y; range, 34-77 y) with 24 mediastinal abscesses underwent 25 CT-guided drainage procedures. Abscess etiologies included esophageal leak after esophagectomy (n = 6), perforated esophageal cancer (n = 4), Nissen fundoplication (n = 3), emetogenic esophageal rupture (n = 3), infectious (n = 2), cardiac surgery (n = 1), iatrogenic (n = 1), gastric strangulation (n = 1), Whipple procedure (n = 1), and thoracotomy for lung cancer (n = 1). Drainages were performed with tandem trocar (n = 14) or Seldinger (n = 11) technique. A total of 25 catheters were used: 8.5 F (n = 9), 10 F (n = 8), 12 F (n = 6), 14 F (n = 1), and 16 F (n = 1). The mean time of catheter drainage was 13.6 days. Technical success was achieved in all 25 attempts (100%). Twenty-two of the 23 patients had complete resolution of the abscess without the need for surgical debridement, for a clinical success rate of 95.6%. One patient underwent technically and clinically successful abscess drainage but required surgical exploration for repair of an anastomotic leak after esophagogastrectomy. There was one complication. One patient had inadvertent placement of a catheter within a pulmonary vein. The catheter was removed after 24 hours without hemodynamic consequences.
  
  
  CONCLUSIONS
  Percutaneous CT-guided drainage of mediastinal abscesses is an uncommon procedure, but the results of this study suggest that it is associated with high technical and clinical success rates.
authors: Department of Radiology, Division of Abdominal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St., White 270, Boston, MA 02114, USA. rarellano@partners.org
authors: Ronald S
authors: RS
authors: Arellano
authors: Debra A
authors: DA
authors: Gervais
authors: Peter R
authors: PR
authors: Mueller
mesh_terms: D000038:Abscess / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D000328:Adult; D000368:Aged; D001900:Boston; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation; D002408:Catheters, Indwelling; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008477:Mediastinal Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D008875:Middle Aged; D015641:Radiography, Interventional / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome