Presentation
Left flank pain. Fever. Ultrasound suggested left kidney mass. Abscess?
Patient Data
Age: 50 years
Gender: Female
From the case:
Renal abscess with CT guided drainage
{"current_user":null,"step_through_annotations":true,"access":{"can_edit":false,"can_download":true,"can_toggle_annotations":true,"can_feature":false,"can_examine_pipeline_reports":false,"can_pin":false},"extraPropsURL":"/studies/67155/annotated_viewer_json?iframe=true\u0026lang=us"}
Large left-sided renal abscess displacing the remaining or the kidney anteriorly. No renal stones.
Gallstones. No free fluid.
{"current_user":null,"step_through_annotations":true,"access":{"can_edit":false,"can_download":true,"can_toggle_annotations":true,"can_feature":false,"can_examine_pipeline_reports":false,"can_pin":false},"extraPropsURL":"/studies/67156/annotated_viewer_json?iframe=true\u0026lang=us"}
Percutaenous drainage requested. Unable to undertake with US
Prone position.
The abscess was entered with an access needle.
Seldinger technique.
12F drain inserted.
Frank pus drained freely.
{"current_user":null,"step_through_annotations":true,"access":{"can_edit":false,"can_download":true,"can_toggle_annotations":true,"can_feature":false,"can_examine_pipeline_reports":false,"can_pin":false},"extraPropsURL":"/studies/67191/annotated_viewer_json?iframe=true\u0026lang=us"}
The key steps in the Seldinger process illustrated.
Case Discussion
CT may be required for drainage procedures.
Reasons include:
- size of patient
- depth of the collection
- unable to get a safe window for drainage
- inadequate visualization (i.e collection of mixed echogenicity)
Unlike ultrasound where a direct puncture is an option for ultrasound-guided drainage, CT requires the Seldinger technique for drain insertion.