CT guided iliopsoas abscess drainage

Case contributed by Dr Ian Bickle

Presentation

Left flank mass. Fevers. LIF pain. Diverticulitis ? Other cause for mass?

Patient Data

Age: 55 years
Gender: Male

Peripancreatic collection with air fluid levels around the body of the pancreas which is tethered to the pylorus and inflammatory changes extending along the splenic hilum. 

Chronic splenic vein commpression with hilar varices.

The peripancreatic collection extending caudally along the left retroperitoneal plane and involving the left iliopsoas muscle; maximum dimension is 5.2 cm.

No signs of diverticulitis.

Post cholecystectomy changes with mild intrahepatic biliary prominence. No hydronephrosis.

No free intraperitoneal fluid or adenopathy.
 

Series of CT fluroscopic images.

Seldinger technique

Initial introducer needle, needle angulation repositioning, advancement of needle, confirmatory position of wire and final drain position.

Case Discussion

Left iliopsoas collection/abscess secondary to pancreatitis.

The site and presence of intervening gas filled structures made this amenable to CT (rather than ultrasound) guided drainage.

Frank pus was aspirated and sent for microbiological analysis.

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