Renal abscess with CT guided drainage

Case contributed by Ian Bickle

Presentation

Left flank pain. Fever. Ultrasound suggested left kidney mass. Abscess?

Patient Data

Age: 50 years
Gender: Female

Large left-sided renal abscess displacing the remaining or the kidney anteriorly. No renal stones.

Gallstones. No free fluid.

Percutaenous drainage requested. Unable to undertake with ultrasound

ct

Prone position.

The abscess was entered with an access needle.

Seldinger technique.

12F drain inserted.     

Frank pus drained freely.

Seldinger technique

Annotated image

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.

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