What is Percutaneous Abscess Drainage?

An abscess is an infected fluid which is collected within the body. In general, people who have an abscess will experience fever, chills and pain in the approximate location of the area that is involved.

If a patient has these symptoms, it is not uncommon that they will undergo an imaging test, (usually a CT scan or an ultrasound), to assist in identifying and making the correct diagnosis of an abscess.

Once the diagnosis of an abscess has been made, your physician and an interventional radiologist will work together to decide the appropriate therapy.

As long as it is deemed safe, percutaneous abscess drainage offers a minimally invasive therapy that can be used to treat the abscess.

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In percutaneous abscess drainage, an interventional radiologist uses imaging guidance (CT, ultrasound or fluoroscopy) to place a thin needle into the abscess to obtain a sample of the infected fluid from an area of the body such as the chest, abdomen or pelvis.

Then, a small drainage catheter is left in place to drain the abscess fluid. It may take several days for all the fluid to be removed.

Occasionally, abscesses that cannot be treated by percutaneous drainage may require surgical drainage in the operating room.

What are some common uses of Percutaneous Abscess Drainage?

Percutaneous abscess drainage is generally used to remove infected fluid from the body, most commonly in the abdomen and pelvis.

The abscess may be the result of recent surgery or secondary to an infection such as appendicitis or diverticulitis. Less commonly, percutaneous abscess drainage may be used in the chest or elsewhere in the body.

What does the equipment look like?

A catheter is a long, thin plastic tube that is considerably smaller than a "pencil lead", or approximately 1/8 inch in diameter.

Percutaneous abscess drainage is typically performed with the guidance of CT, ultrasound or x-ray fluoroscopic imaging.

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CT

The CT scanner is typically a large, box-like machine with a hole or short tunnel in the center. You will lie on a narrow examination table that slides into and out of this tunnel. Rotating around you, the x-ray tube and electronic x-ray detectors are located opposite each other in a ring, called a gantry.

The computer workstation that processes the imaging information is located in a separate control room, where the technologist operates the scanner and monitors your examination in direct visual contact and usually with the ability to hear and talk to you with the use of a speaker and microphone.

Ultrasound

Ultrasound scanners consist of a console containing a computer, a video display screen and a transducer that is used to do the scanning. The transducer is a small hand-held device that resembles a microphone, attached to the scanner by a cord.

Some exams may use different transducers (with different capabilities) during a single exam. The transducer sends out high-frequency sound waves (that the human ear cannot hear) into the body and then listens for the returning echoes from the tissues in the body. The principles are similar to sonar used by boats and submarines.

The ultrasound image is immediately visible on a video display screen that looks like a computer or television monitor.

The image is created based on the amplitude (loudness), frequency (pitch) and time it takes for the ultrasound signal to return from the area within the patient that is being examined to the transducer (the device placed on the patient's skin to send and receive the returning sound waves), as well as the type of body structure and composition of body tissue through which the sound travels.

A small amount of gel is put on the skin to allow the sound waves to travel from the transducer to the examined area within the body and then back again. Ultrasound is an excellent modality for some areas of the body while other areas, especially air-filled lungs, are poorly suited for an ultrasound.

X-ray

The equipment typically used for this examination consists of a radiographic table, one or two x-ray tubes and a television-like monitor that is located in the examining room.

Fluoroscopy, which converts x-rays into video images, is used to watch and guide the progress of the procedure. The video is produced by the x-ray machine and a detector that is suspended over a table on which the patient lies.

Other equipment that may be used during the procedure includes an intravenous line (IV), ultrasound machine and devices that monitor your heartbeat and blood pressure.

How is the Percutaneous Abscess Drainage performed?

1. Image-guided, minimally invasive procedures such as percutaneous abscess drainage are most often performed by a specially trained interventional radiologist in an interventional radiology suite or under CT guidance in a separate area of the radiology department.
2. You will be positioned on the examining table.
3. You may be connected to monitors that track your heart rate, blood pressure and pulse during the procedure.
4. A nurse or technologist will insert an intravenous (IV) line into a vein in your hand or arm so that sedative medication can be given intravenously.
5. Your physician will numb the area with a local anesthetic.
6. The area of your body where the catheter is to be inserted will be sterilized and covered with a surgical drape.
7. A very small skin incision is made at the site.
8. After the patient is sedated for the procedure, the interventional radiologist uses image-guidance to place a catheter (a long, thin, hollow plastic tube) through the skin and into the abscess to allow for drainage of the infected fluid.
9. Your intravenous line will be removed.
10. This procedure is usually completed in 20 minutes to an hour.
11. Once in place, the catheter is connected to a drainage bag outside of your body. The catheter will remain in place until the fluid has stopped draining and your infection is gone. It may take several days to drain the abscess.

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