E-ISSN 1305-3612
Interventional Radiology - Original Article
Image-guided catheter drainage of infected pleural effusions
1 Department of Radiology, Hacettepe University School of Medicine, Ankara  
2 From the Department of Radiology, Hacetttepe University School of Medicine, Ankara, Turkey  
3 Departments of Radiology, Hacettepe University School of Medicine, Ankara, Turkey  
Diagn Interv Radiol 2007; 13: 204-209

Key Words: empyema • drainage • intracavitary fibrinolytic instillation
Abstract

PURPOSE
To evaluate the safety and efficacy of image-guided drainage of infected pleural effusions.

 

MATERIALS AND METHODS
The clinical outcomes of 93 patients who underwent image-guided drainage of infected pleural effusions between 1998 and 2003 were retrospectively analyzed. Among the 93 patients, 31 (33.3%) were younger than 16 years of age. In all, 129 catheters (8F–14F pigtail catheters) were placed under ultrasonography (US) or computed tomography guidance. In 27 patients (29.0%) intracavitary fibrinolytic therapy with streptokinase was employed to improve drainage. The patients were followed up during daily rounds and, when drainage problems occurred, catheters were exchanged or repositioned. New catheters were placed for undrained loculations.

 

RESULTS
The success, failure, and recurrence rates were 92.5% (86/93), 7.5% (7/93), and 6.4% (6/93), respectively. In the pediatric age group the success rate was significantly higher. Intracavitary fibrinolytic therapy significantly improved daily output, but did not significantly reduce drainage duration or hospital stay. There was no significant difference between the successful and failed treatment cases in terms of US findings, gross appearance, or culture positivity. The only major complication was anaphylactic reaction due to intracavitary instillation of streptokinase (n = 1, 1.1%). The 30-day mortality rate was 2%.

 

CONCLUSION
Image-guided catheter drainage of infected pleural collections is a safe and effective method. Addition of intracavitary fibrinolytic instillation improves drainage, but early intervention prior to collections becoming more complicated remains an important factor in determining prognosis. Non-loculated anechoic collections without septa have a high probability of favorable outcome.

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