Presentation
Fever of unknown origin
Patient Data
There is a large left retroperitoneal collection with air foci extending from the left kidney down to the left side of the pelvis. A bulky left iliopsoas muscle with haziness, stranding, and fluid attenuation is also noted.
Steps of CT-guided tube insertion:
A preliminary CT film was used to locate the collection accurately.
The overlying skin was marked with a metallic object.
A local anesthetic was injected at the insertion site
The tube was inserted at the site of the external mark on the skin to the depth measured in the preliminary CT films.
A post-procedural film was obtained to confirm the correct location of the tube tip.
Post-procedural follow-up films revealed a remarkable regressive course regarding the size of the left retroperitoneal abscess. The left iliopsoas abscess showed a stationary course. Note the smaller right psoas collection with marginal enhancement (not appreciated in the non-contrast study).
The reduced size of the collection is noted by comparing pre-procedural (white arrow) and post-procedural (yellow arrow) films.
Case Discussion
CT-guided tube drainage is a safe and minimally invasive procedure. It is used for abdominopelvic abscesses not accessible by ultrasound-guided drainage. Psoas and retroperitoneal collections are difficult to be drained guided by ultrasound. In this case, the CT is used to evaluate the presence of an interposed structure in the path as a bowel loop or a vessel. In our case, we present a successful CT-guided tube drainage procedure for a retroperitoneal abscess. The successful drainage is evidenced by the reduced size of the collection and the decreased leukocytic count.
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