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ABSTRACT: PurposePsoas abscesses are the most frequent complication of tuberculosis with skeletal involvement. The aim of this paper is to
report our experience with the systematic application of percutaneous drainage to tuberculous psoas abscesses.
Materials and methodsBetween January 1997 and December 2005, 23 patients (14 men and nine women; age range 21–48 years), after a previous study
with computed tomography (CT) and/or magnetic resonance (MR) imaging, underwent percutaneous drainage of a tuberculous fluid
collection in the psoas muscles. Follow-up consisted of monthly clinical and laboratory assessment, and plain chest radiography
and spinal CT every 6–12 months.
ResultsSpondylodiscitis involved the thoracolumbar spine. Fluid collections were bilateral in 14 cases and communicating in ten of
these. Maximum transverse diameter was 7 cm, whereas longitudinal diameter was 14 cm. Placement of the drainage catheter was
successful in all cases, and the catheter was left in place for 5–36 (mean 18.4) days. Symptom regression occurred immediately
after drainage of the fluid collection. The drainage procedure was curative in 100% of cases. Dislodgement of the drainage
catheter occurred in two cases as a result of excessive traction during dressing removal.
ConclusionsA serious complication of bone tuberculosis, psoas abscesses, can be effectively treated by percutaneous drainage, leading
to immediate pain resolution. The drainage catheter requires daily monitoring to identify when it can be safely removed without
risk of recurrence.
ObiettivoGli ascessi dei muscoli psoas rappresentano la complicanza più frequente della malattia tubercolare con localizzazione ossea.
Scopo del lavoro è riportare la nostra esperienza nell’applicare sistematicamente il drenaggio percutaneo a tali raccolte
fluide.
Materiali e metodiTra gennaio 1997 e dicembre 2005, 23 pazienti (14 uomini e 9 donne), di età compresa tra i 21 ed i 48 anni, precedentemente
studiati con TC e/o RM, sono stati sottoposti a drenaggio percutaneo di una raccolta fluida, di origine tubercolare, localizzata
nei muscoli psoas. Il follow-up è consistito in una valutazione clinica e di laboratorio mensile, una radiografia diretta
del torace e una TC della colonna ogni 6–12 mesi.
RisultatiLa spondilodiscite era localizzata a livello dorsale e lombare; le raccolte erano bilaterali in 14 casi: di queste, 10 erano
comunicanti. Il massimo diametro trasverso è stato di 7 cm, mentre quello longitudinale è stato di 14 cm. Il posizionamento
del catetere di drenaggio è sempre avvenuto con successo, con una permanenza del catetere di 5–36 giorni (media 18,4 giorni);
la regressione della sintomatologia è avvenuta già all’atto dell’evacuazione della raccolta fluida. Il drenaggio è risultato
curativo nel 100% dei casi. Abbiamo registrato la dislocazione del catetere di drenaggio in 2 casi, per eccessiva trazione
dello stesso, durante le fasi della medicazione.
ConclusioniGli ascessi dei muscoli psoas rappresentano una seria complicanza nella localizzazione ossea della tubercolosi, trattabili
efficacemente con il drenaggio percutaneo, capace di risolvere subito la sintomatologia dolorosa. Il catetere di drenaggio
necessita di un’assistenza giornaliera, per poter decidere il momento più idoneo alla sua rimozione, senza andare incontro
a recidive.
La radiologia medica 04/2012; 114(6):984-995. · 1.44 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Psoas abscesses are the most frequent complication of tuberculosis with skeletal involvement. The aim of this paper is to report our experience with the systematic application of percutaneous drainage to tuberculous psoas abscesses.
Between January 1997 and December 2005, 23 patients (14 men and nine women; age range 21-48 years), after a previous study with computed tomography (CT) and/or magnetic resonance (MR) imaging, underwent percutaneous drainage of a tuberculous fluid collection in the psoas muscles. Follow-up consisted of monthly clinical and laboratory assessment, and plain chest radiography and spinal CT every 6-12 months.
Spondylodiscitis involved the thoracolumbar spine. Fluid collections were bilateral in 14 cases and communicating in ten of these. Maximum transverse diameter was 7 cm, whereas longitudinal diameter was 14 cm. Placement of the drainage catheter was successful in all cases, and the catheter was left in place for 5-36 (mean 18.4) days. Symptom regression occurred immediately after drainage of the fluid collection. The drainage procedure was curative in 100% of cases. Dislodgement of the drainage catheter occurred in two cases as a result of excessive traction during dressing removal.
A serious complication of bone tuberculosis, psoas abscesses, can be effectively treated by percutaneous drainage, leading to immediate pain resolution. The drainage catheter requires daily monitoring to identify when it can be safely removed without risk of recurrence.
La radiologia medica 07/2009; 114(6):984-95. · 1.44 Impact Factor
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ABSTRACT: Lumbar sympathectomy is a complementary therapeutic option for patients with severe peripheral vascular occlusive disease presenting rest pain or gangrene and not eligible for surgical revascularisation. Traditional surgical sympathectomy was widely used in the past. However, due to its invasive character, it has increasingly been replaced by percutaneous techniques and, in some recent cases, by laparoscopic procedures. Percutaneous lumbar sympathectomy is a safe, cost-effective and widely available treatment option. We report our experience on 19 patients subjected to percutaneous sympathectomy under CT guidance.
Between 1998 and 2000, 19 patients underwent percutaneous sympathectomy under CT guidance. All patients had severe vascular disease of the lower extremities (Fontaine stage IV), with rest pain and gangrene. They were not eligible for surgical revascularisation. Phenol was injected at the level of L2 and L4 using two 22 G needles (15 cm long). Signs of interrupted sympathetic activity usually occur 2'-15' after the procedure with warmth and flushing and dryness of the lower extremities.
Percutaneous sympathectomy under CT guidance is a simple, safe and well-tolerated procedure with a low rate of complications. Of the 19 patients, 9 (47.3%) showed clinical improvement, whereas 5 experienced a worsening of ischaemia in the months immediately following the procedure.
Results suggest that percutaneous lumbar sympathectomy causes a sympathetic blockade in patients with advanced vascular disease of the limbs. CT guidance ensures a high level of precision in drug dosing, thus lowering the risk of complications. Although the results are demoralizing. the impossibility of achieving surgical revascularisation in advanced peripheral arteriosclerosis enhances the role of CT-guided percutaneous sympathectomy in relieving rest pain and healing ulcers in order to postpone the amputation.
La radiologia medica 05/2005; 109(4):430-7. · 1.44 Impact Factor
