351 Percutaneous Drainage of Renal Abscesses John J. Cronan1 Edward S. Amis, Jr.2 Gary S. Dorfman1 Received May 23, 1983; accepted after revision 5eptember 30, 1983. ‘ Department of Diagnostic Radiology, Brown University Program in Medicine. Rhode Island Hos- pital, 593 Eddy St., Providence, RI 02902. Address reprint requests to J. J. Cronan. 2 Department of Radiology. Naval Hospital and Uniformed Services University of the Health Sci- ences, Bethesda, MD 20814. AJR 142:351-354, February 1984 0361 -803X/84/1 422-0351 : American Roentgen Ray Society Percutaneous drainage combined with cross-sectional imaging is reported in five patients with intrarenal abscesses. No recurrences and no complications occurred. This nonsurgical approach avoids the risks inherent in surgical therapy. Combined with appropriate antibiotic coverage, percutaneous drainage is an effective nonsurgical therapy for unilocular intrarenal abscesses. A renal abscess is life-threatening. Even in the era of antibiotics, up to 50% of patients eventually die of the disease with one-third of cases undiagnosed before surgery [1 ]. With the introduction of cross-sectional imaging, identification of renal abscesses has become easier. A nonlobar, homogeneous, low-density intrarenal lesion detected by computed tomography (CT) strongly suggests necrosis and abscess formation [2]. Diagnostic aspiration and drainage of these collections is a logical extension of percutaneous techniques currently used for drainage of other intraabdominal fluid collections. Successful percutaneous drainage obviates ne- phrectomy or open surgical drainage. Subjects and Methods Between January 1981 and January 1983, five intrarenal abscesses were diagnosed and treated by percutaneous catheter drainage. The one male and four female patients were 7- 69 years old. Fever, leukocytosis, elevated sedimentation rate, and positive blood cultures were present in each case. After a diagnosis of possible renal abscess was made, each patient underwent CT- or sonography-guided aspiration with a 22 gauge needle. Percutaneous catheter placement was considered only after aspiration and Gram stain confirmed the presence of pus. Appropriate antibiotics were started in all patients after diagnostic needle aspiration. Actual placement of the drainage catheter was done under CT or fluoroscopic control. Seldinger or trocar technique was used depending on the size and position of the abscess, using techniques similar to those of abdominal abscess drainage procedures (3, 4]. A satisfactory response was marked by diminished fever, white blood cell count, and drainage catheter output, and by resolution of the cavity as determined by CT or direct injection of contrast material into the cavity. Results Catheter drainage was successful in our five cases. No patient required surgical drainage or experienced a relapse after catheter removal. Catheter drainage varied from 5 to 1 1 days. Removal of the catheter occurred when drainage had ceased for 48 hr and contrast injection into the cavity showed no residual lumen. Follow- up has been 4-28 months and no recurrences have been observed. Downloaded from www.ajronline.org by 52.73.204.196 on 05/16/22 from IP address 52.73.204.196. Copyright ARRS. For personal use only; all rights reserved