Treatment of deep intramuscular and musculoskeletal abscess

Experience with 99 CT-guided percutaneous catheter drainage procedures

Carmel G. Cronin, Debra A. Gervais, Peter F. Hahn, Ronald Arellano, Alexander Guimaraes, Peter R. Mueller

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

OBJECTIVE. The purpose of this article is to describe our experience draining deep muscular and musculoskeletal abscess collections with CT guidance, emphasizing clinicopathologic factors associated with drain failure, and to further analyze patient outcomes according to whether the process involves muscle alone or also involves adjacent bone or joint (skeletal involvement). MATERIALS AND METHODS. The details of percutaneous catheter drainage were retrospectively recorded for all drainages performed over a 9-year period. The technical and clinical successes of percutaneous catheter drainage were determined. Multifactor logistic regression analysis was used to identify predictors of drain failure (malignancy, age, chemotherapy, surgery, infection, complexity, size, days in situ, and skeletal involvement). These parameters were assessed in all patients, those with muscle involvement alone and those with musculoskeletal collections. RESULTS. Eighty-nine of 94 patients underwent one percutaneous drainage procedure and 5 of 94 patients underwent two drainages for a total of 99 drainages in 94 patients (one drainage [n = 89] and two drainages [n = 5]). There were 62 men and 32 women with a mean age of 58.5 years (age range [±SD], 22.3-88.0 ± 16 years). The abscess diameters ranged from 1.8 to 13 cm (mean, 5.3 ± 2.5 cm), volume aspirated ranged from 0 to 200 mL (mean, 45 ± 44 mL), and mean duration of drainage was 16.2 days (range, 2-110 ± 18.7 days). The iliopsoas muscle was the most common site of drainage, accounting for 87.8% of the total. Catheter insertion was possible in all patients, with the muscular component successfully drained in 82% (81/99) overall: 85% (46/54) of those with muscle involvement alone and 77% (35/45) of those with musculoskeletal collections. Catheter drainage and antibiotic administration resulted in 65.6% (65/99) not requiring any surgical intervention and resolution of abnormal white cell count or fevers in 98.8% (79/80) of those with abnormal parameters before treatment. Skeletal infection was associated with increased risk of drainage failure (p = 0.0001). CONCLUSION. Percutaneous imaging-guided musculoskeletal drainage is clinically useful, safe, and effective for draining complex musculoskeletal collections. It is highly effective for draining collections involving muscle alone; however, skeletal infection is associated with a higher risk of drain failure.

Original languageEnglish (US)
Pages (from-to)1182-1188
Number of pages7
JournalAmerican Journal of Roentgenology
Volume196
Issue number5
DOIs
StatePublished - May 2011
Externally publishedYes

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Abscess
Drainage
Catheters
Therapeutics
Muscles
Infection
Fever
Cell Count
Joints
Logistic Models
Regression Analysis
Anti-Bacterial Agents
Bone and Bones
Drug Therapy

Keywords

  • Abdominal drainage
  • Muscle abscess
  • Musculoskeletal collection

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Treatment of deep intramuscular and musculoskeletal abscess : Experience with 99 CT-guided percutaneous catheter drainage procedures. / Cronin, Carmel G.; Gervais, Debra A.; Hahn, Peter F.; Arellano, Ronald; Guimaraes, Alexander; Mueller, Peter R.

In: American Journal of Roentgenology, Vol. 196, No. 5, 05.2011, p. 1182-1188.

Research output: Contribution to journalArticle

Cronin, Carmel G. ; Gervais, Debra A. ; Hahn, Peter F. ; Arellano, Ronald ; Guimaraes, Alexander ; Mueller, Peter R. / Treatment of deep intramuscular and musculoskeletal abscess : Experience with 99 CT-guided percutaneous catheter drainage procedures. In: American Journal of Roentgenology. 2011 ; Vol. 196, No. 5. pp. 1182-1188.
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AU - Guimaraes, Alexander

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N2 - OBJECTIVE. The purpose of this article is to describe our experience draining deep muscular and musculoskeletal abscess collections with CT guidance, emphasizing clinicopathologic factors associated with drain failure, and to further analyze patient outcomes according to whether the process involves muscle alone or also involves adjacent bone or joint (skeletal involvement). MATERIALS AND METHODS. The details of percutaneous catheter drainage were retrospectively recorded for all drainages performed over a 9-year period. The technical and clinical successes of percutaneous catheter drainage were determined. Multifactor logistic regression analysis was used to identify predictors of drain failure (malignancy, age, chemotherapy, surgery, infection, complexity, size, days in situ, and skeletal involvement). These parameters were assessed in all patients, those with muscle involvement alone and those with musculoskeletal collections. RESULTS. Eighty-nine of 94 patients underwent one percutaneous drainage procedure and 5 of 94 patients underwent two drainages for a total of 99 drainages in 94 patients (one drainage [n = 89] and two drainages [n = 5]). There were 62 men and 32 women with a mean age of 58.5 years (age range [±SD], 22.3-88.0 ± 16 years). The abscess diameters ranged from 1.8 to 13 cm (mean, 5.3 ± 2.5 cm), volume aspirated ranged from 0 to 200 mL (mean, 45 ± 44 mL), and mean duration of drainage was 16.2 days (range, 2-110 ± 18.7 days). The iliopsoas muscle was the most common site of drainage, accounting for 87.8% of the total. Catheter insertion was possible in all patients, with the muscular component successfully drained in 82% (81/99) overall: 85% (46/54) of those with muscle involvement alone and 77% (35/45) of those with musculoskeletal collections. Catheter drainage and antibiotic administration resulted in 65.6% (65/99) not requiring any surgical intervention and resolution of abnormal white cell count or fevers in 98.8% (79/80) of those with abnormal parameters before treatment. Skeletal infection was associated with increased risk of drainage failure (p = 0.0001). CONCLUSION. Percutaneous imaging-guided musculoskeletal drainage is clinically useful, safe, and effective for draining complex musculoskeletal collections. It is highly effective for draining collections involving muscle alone; however, skeletal infection is associated with a higher risk of drain failure.

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