Percutaneous

Treatment

Abscesses:
Catheter
Chaturbhuj Sanjay Yogesh Madhu Sudha La) Rajak1
OBJECTIVE.This ically guided percutaneous of liver abscesses.

Needle Drainage
study was designed needle aspiration

Liver Aspi ration Versus

of

to determine

and compare catheter

the efficacy drainage

of sonograph-

Sanjay Gupta
Jam2 Chawla3 Gulati1

and percutaneous

in the treatment and 12 fepyogenic. or catheter

Sun1

SUBJECTS AND METHODS. In a randomized study, males; age range, 2-72 years; average age, 35 years) with liver 1 1 ; indeterminate, 19) underwent either percutaneous needle

50 patients
abscesses aspiration

(38 males
(amebic.
(ii
=

20; 25)

drainage

(n

25) along with appropriate

antimicrobial

therapy.

In patients

assigned

to the needle

aspiration group, an 18-gauge needle was used to aspirate the abscess cavity. was attempted only once in each patient not responding to the first aspiration: second
drainage drainage,

Repeated aspiration nonresponse to the were group).

using

aspiration (however,
8- to

was considered these patients

catheters 1 2-French

failure were
were

of treatment,
introduced into

and these patients drainage

cavity the abscess

given
the

catheter
Seldinger

not included

in the catheter

For catheter

technique. In patients with multiple abscesses group), all the abscesses except those smaller ment. Patients were followed hospital stay, and development during hospitalization. After

(seven in aspiration group and five in catheter than 3 cm were subjected to percutaneous treat-

up to assess the outcome of the percutaneous treatment, length of of any complications. Sonography was performed every third day discharge of the patient, periodic clinical and sonographic in only examinaof the in all 25

tions were done until total resolution of abscesses was achieved. RESULTS. Although percutaneous needle aspiration was successful
25 patients

15 (60%)

after

one (n

1 1) or two (n

4) aspirations.

catheter

drainage

was curative

patients (100%) (p < .05). Among the successfully treated patients, the average time for clinical improvement and the mean hospital stay were similar in the two treatment groups. Although the average time
taken

needed
in the

for a 50%
aspiration

reduction
than

in the size of the abscess

in the catheter was was the group

cavity

was significantly versus

and

(p the aver-

<

.05)
age

greater time

group

( 1 1 days

S days).

for total

resolution
which

of abscess No relapse
ranged

same ( I S weeks)
on

in both groups.

No major ex-

complications
amination during

were encountered.
follow-up,

documented 8 to 37 weeks.

clinical

sonographic

from

CONCLUSION. Our results show that percutaneous catheter drainage is more effective than needle aspiration in the treatment of liver abscesses. Needle aspiration. if limited to two attempts, has a high failure rate.

Received July 29, 1997; accepted October22, 1997.

1 Department

after revision Postgraduate Chandigarh, to S. Sun. PGIMER, Chandigarh, Institute of

L
Pin. 160012

iver

abscesses,

pyogenic, portant mortality

mode medical; abscesses

both amebic and continue to be an imof morbidity The liver

as to

13, 4].
ated

However,

operative (10-47%)

drainage

is associ-

with

significant

morbidity

and

of Radio-Diagnosis, and Research, Medicine,

cause of amebic
as many refractory

and primary is
ther-

mortality

[4-61.

In

recent

years,

imaging-

Medical

Education

in tropical of treatment
however, may be

countries.

India. Address 2Department 3Department

correspondence of Internal

abscess

guided percutaneous drainage has been increasingly used to treat liver abscesses. with reported 100% placement method
abscesses

15% of amebic
medical

success

rates 1].
an

ranging Although

from
catheter

70%
is

to
the

Pin. 160 012 India. of Hepatology, PGIMER. Chandigarh.

Pin. 160 012 India. AJR 1998:170:1035-1039 0361-803X/98/1704-1 035

Ray Society

apy may
scesses

[I I. Also,
complicate
[2]. In

[5,
of

7-1

percutaneous to drain
have

secondary bacterial 20% of amebic

such

infection liver ab-

indwelling

most

widely

preferred
studies

liver
shown

with

pyogenic
the

liver

patients and in patients abscesses, surgical drainmode of treatment

[8-131,

recent

American

Roentgen

age has been

traditional

therapeutic less costly,

needle aspiration to be a simpler. and equally effective mode of

AJR:17O, April 1998

1035

Rajak

et al.

treatment

I 14,
the relative

1 SI. We

conducted in 50 patients
and efficacy needle

a prospecto deterof the two

lf:1Patient

and

Abscess

Characteristics

in the Two
Treatment

Treatment Group Catheter 4-65 (35.6) l9maIe,6female 23 patients 25 patients 3 patients

20 patients 32 (31b) 20 patients

Groups

tive randomized
mine procedures

study
safety (percutaneous

and

percutaneous

catheter

aspiration drainage) in the

Characteristic

Needle Aspiration Patient age (average) Sex Fever >37.2#{176}C Pain and tenderness
abdomen

(n

25)

Drainage

(n

25)

treatment

of liver abscesses.

(yr)

2-72 (35.44) l9male,6female 25 patients

Subjects Subjects
Fifty

and Methods

in upper

25 patients 3 patients

patients

with

liver

abscesses

referred

to the for 1994 The nonof

Jaundice
Leukocytosis (>10,000/mm3)a

Department percutaneous
and Febmary indications

of Radio-Diagnosis

at our institution

22 patients

management
1997 were for percutaneous

between
included interventions

February
in this study. were

Number of abscesses
Solitary

43 (37b)
l8patients

response to medical therapy and imminent rupture abscess [9. 1 1 1. Patients who did not res)nd
medical show signs derness therapy any clinical of deterioration and enlarging included (i.e.. 22 patients or increasing who who pain did and improvement showed

Multiple Location
Right

7 patientsc of abscesses 17 patients 3 patients 5 patients 10-847 ml (221.86 205.49 ml) 16 abscesses 11 patients 6 patients 8patients
six in aspiration
group

5 patientsd 17 patients 4 patients 4 patients 33-1834 ml (335.74 376.72 ml) 14 abscesses 9 patients 5 patients 11 patients
and one in catheter groupl measuring <3 cm in their

to
not ten-

lobe

Left lobe Both lobes Volume of percutaneously treated abscesses e (mean SO)

abscess size on serial sonogra-

phy while on medical therapy). Patients with imminent rupture of abscess included 28 patients in whom sonography showed a thin (<I cm) rim or no discernible hepatic parenchyma around any part of the circumference of the abscess. Patients with already ruptured abscesses were not included in this study. The patients were randomly assigned to undergo either percutaneous needle aspiration (n = 25) or percutaneous catheter drainage (n = 25) along
with appropriate included antimicrobial 38 males therapy. and The patient who population 12 females

Signs of impending
Cause of abscesses Amebic Pyogenic Indeterminate

rupture

alotal leukocyte count. bIn patients with multiple abscesses, abscesses largest dimension were not treated percutaneously.
ciwo

to six abscesses:

mean, 3.57.
x

were 2-72 years old (mean age. 35 years old). The patient characteristics in the two treatment groups are summarized in Table I . The two groups were similar in all respects except for the volume of
abscesses; the average volume of abscesses (336 ml)

dTwo to three abscesses; mean, 2.4. eVolume of abscesses was calculated using the formula of an ellipse: 0.523 x length

breadth

height.

was larger in the catheter drainage group than the average volume (222 ml) in the needle aspiration group. Amebic abscesses were diagnosed in 20 of the 50 patients on the basis of positive findings on an mdirect hemagglutination test (titer, l : 128). In I I of the
50 patients, the abscesses were pyogenic as sug-

received appropriate blood products for correction to acceptable levels of coagulation factors. The percutaneous treatment procedures were performed under local anesthesia (2% lignocaine)
with IV analgesia and sedation when required. The

4600 kee, sector Systems.

(General WI) and Issaquah.

Electric Sonoline WA)

Medical 51-450 systems were was

Systems. (Siemens used.

MilwauMedical

and 3.5- or 5-MHz aspiration into the in an In the

or convex transducers In the patients assigned

an I 8-gauge needle cavity

to the needle advanced were the

were performed under continuous realtime sonographic guidance using the freehand technique. For sonographic guidance. RT 3600 and RT
procedures
S Of

group. abscess attempt

and the contents evacuate

aspirated cavity.

to completely

gested

of the aspirated pus. The specific organisms cultured were Staphylococcus aureus in five patients and a-hemolytic streptococcus. hemolytic streptococcus, Klebsie!k, pneunioniae, Escherichia coli. Acinetobacter anitratus, and Enterococcus faecalis

by the culture

Percutaneous
Ur Ac.u.s

Needle

Asplration

and Catheter

Drainage

In 50

ots

in one

patient

each.

In the other

although the abscess cavity aspirates were frankly purulent on visual inspection and showed the
19 patients, presence cytes of innumerable polymorphonuclear leuko-

on cytologic examination. no organisms were identified and the findings of both amebic serology and pus cultures were negative: hence. the cause of these abscesses could not be definitely established.

Methods

Informed

consent determined

was taken

from

all the patients

undergoing
factors were

percutaneous

treatment.
in all patients

Coagulation
before the Note-NA
=

not applicable.
group) showed small residual cavities -3 cm) at 10-12 weeks

scheduled procedure to rule out any bleeding disorder. Three patients with evidence of coagulopathy

#{149}Three patients (one in aspiration group and two in catheter but were lost to further follow up.

1036

AJR:17O, April 1998

Percutaneous

Treatment

of Liver

Abscesses longed
gram

seven abscesses sion) dle

patients (which were aspiration

with were was

multiple to needle attempted

abscesses. aspiration; in 37

all but largest of thus. the

six nee43

<3 cm in their

dimen-

subjected in this group

normalized, follow-up imaging showed resolution of the abscess (total resolution or reduction in size to <3 cm), and no evidence of relapse or recurrence
was seen during follow-up.

(35 days) in only one patient; obtained and

with

a cavitorevealed This disbe-

in with three
catheters

this more

patient patients

communication patient

the biliary
in situ

system. were
they when

abscesses

of patients.

For percutaneous catheter drainage, appropriatesized catheters (8- to I 2-French pigtail or Malecot
drainage introduced Seldinger scesses, catheter: and each two catheter: into technique. abscess catheters Cook, the Bloomington, abscess In patients was were drained used cavity with with IN) using multiple were the ab-

The chi-square test with Yates correction was used to analyze the success rates of the two treatment techniques. A nonpaired Students t test was used to assess periods the statistical significance and of differences in the

charged
came drainage

clinically
from the

stable
catheter;

but

had
the

persistent
patients at-

a separate patients

in four

one patient needed three catheters. The cathetens were connected to a completely closed collecting system
A daily

the time needed for clinical improvement, 50% reduction in size of abscess cavity, and total or near-total resolution of the abscess after percutaneous treatment. A p value of less than .05 was considered statistically significant.
of hospitalization

the outpatient department on alternate days until catheter removal. Among the successfully treated patients, the average time needed for clinical relief (detended
fervescence)

and the time

mean needed

hospital groups

stays (Table

were 2). of the

similar Although Results The results of percutaneous in Table 2.

aspiration

in the two treatment

and routine estimate

catheter fluid sterile was saline

care

was

instituted. Irrigation daily removed symptoms counts), to

of the amount,
with

color, and consisrecorded. was done were local

for reduction

tency avoid

of the drainage catheter defervescence normalization blockage.

of the catheter

needle

aspira-

Catheters

tion and percutaneous

catheter drainage

in the

when
(i.e.. and

the patients

showed
and relief of elevated

clinical
from

improvement

50 patients are given

Percutaneous needle

abscess cavity to 50% of its original size was significantly more in the needle aspiration group than in the percutaneous catheter drainage group ( I I days versus 5 days), the average
time taken for total or near total resolution of the abscess was similar in both groups of patients (Table 2). In three patients, small (2-3 cm) 10-12 were residual weeks lost cavities after were drainage; still present patients at these

was successpaThe

leukocyte

the catheter output dropped to less than 10 ml/24 hr for 2 consecutive days, and follow-up sonography
showed tests negligible pus residual was cavity. and microbiologic oran day Aspirated examined

ful in 15 (60%) of the 25 patients. Eleven tients responded to a single aspiration. other
piration

14 patients were subjected to a second as2-7 days (average, 3 days) later for one

were performed to determine the causative ganism. Broad spectrum antibiotics, including
aminoglycoside (cloxacillin at 150 mg/kg per

or both of the following fever lation and leukocytosis

reasons: persistence of
(n as
=

to further

follow-up.

No relapse (range, 8-37

1 1) and reaccumuby follow-up

was documented

on clinical

and sonographic

of the
(n

abscess
=

shown

IV and gentamicin at 4.5 mg/kg per day IV) with metronidazole (500 mg IV or 800 mg orally three times a day) and chloroquine. were initiated. Once the lalxwatory results were available, antibiotics were changed on the basis of sensitivity tests. However, patients in whom pus culture findings were negative were continued on the same broad spectrum antibiotics and antiamebic drugs. The antibioticy and

sonography

I 2). Only

four of these 14 pa-

examination during follow-up weeks; mean, 20 weeks).

tients responded to a second aspiration. Percutaneous needle aspiration was considered cause unsuccessful they failed in to 10 patients improve (40%) clinically aspiration evacuate beor

No major complications were encountered. Three patients, two in the catheter group and

radiologically even after a second In three of these patients, needle

(both

aspiration.

one in the aspiration group, had minor complications. One patient complained of severe pain at the catheter entry site that was relieved
with oral analgesic. with of the
within

A pericatheter debris;

leak devel-

metronidazole and 14 days, in the

were dosage

given of 600

for a duration Chloroquine mg daily for

of was 2

attempts)

failed

to completely

oped in another patient because ofblockage

the catheter the leak stopped

of
after

10 days given days

respectively.

orally
followed

by 300 mg daily

for 19 days.

the abscess cavity because of the thick viscous nature of the pus. Rapid reaccumulation in the abscess cavity was seen in eight of these 10
patients within 3-6 days after the second
in whom needle

flushing
Hemorrhage

catheter with sterile the abscess cavity

during needle

saline.

develaspira-

All patients were followed up to assess the time needed for clinical improvement. length of hospital
stay. odic and development size until of any the patients complications. were hospitalized. Pen-

aspia.spira-

oped

in the third patient

ration. The average volume

ml) in the 10 patients

of abscesses (425
significantly volume (p
<

sonography

was done every

third day to assess

tion was
.05)

unsuccessful than

was

tion, as suggested by the sudden appearance of echogenic foci within the homogeneously hypoechoic abscess cavity and the mixture of
blood with the aspirated

the cavity

larger

the average

( 178 ml) who reHowever, were Subse-

Patients in the percutaneous needle aspiration group who did not improve clinically after the first aspiration and continued to have leukocytosis or showed refilling of the abscess cavity on follow-up
sonography were subjected to a second aspiration.

of the other
similar

abscesses in the 15 patients sponded to one or two aspirations. patient and abscess two groups
with

was treated conservatively

IV fluids.

material; this patient with bed rest and

characteristics of patients.

in these
treated (however, included

Failure of the patient to improve after a second aspiration was considered as failure of aspiration therapy. After discharge, all patients were followed up with periodic clinical and sonographic examinations to assess for any recurrence of the disease and

quently, fully
drainage are not

all of these 10 patients

percutaneous in our study, in the

were successcatheter

Discussion In recent ous

drainage) years, imaging-guided

these

patients
drainage

treatment

(needle

aspiration
surgical

percutaneor catheter
as

catheter

has replaced

intervention

group). these

A cavitogram

was obtained because the communication was successful

for two of fluid was seen in all 25 catheter

to monitor the size of the abscess cavity. The patients were examined weekly for I month, monthly for the next 3 months. and at two monthly intervals thereafter until complete resolution of the abscess
was achieved.

10 patients

drainage

the primary treatment for liver abscesses [5, 7-1 1 ]. The main advantages of needle aspiration over catheter drainage include the foland

was bilious; biliary in both patients. Catheter patients drainage (100%)

lowing: Needle less expensive; follow-up

nursing care

aspiration

is less

invasive

it avoids care,
is required;

problems so less
and multiple

related medical
cavities

to or

Treatment was considered successful if all of the following criteria were met: The patients improved
clinically and (i.e.. subsidence elevated of fever leukocyte and local counts signs were symptoms).

of the percutaneous

catheter

drainage group. In most patients (n = 24), duration of catheter drainage varied from 3 to 15 days (average, 7 days). The duration was pro-

can be aspirated However,

in the same session [14, 15].

shows, needle aspira-

as our study

AJR:170, April 1998

1037

Rajak

et al.

tion,
cantly

if limited
lower

to two attempts,
success rate

has a signifithan catheter

In contrast tion, percutaneous catheter

accumulation

to percutaneous placement continuous

are

needle aspiraof an indwelling

may
ally

persist

for years.

Such from

cavities simple

are usuhepatic Singh and

indistinguishable

drainage (60% versus 100%). The success rate of percutaneous needle aspiration in the various series reported in the literature varies from 79% to

provides

drainage; evacuation

hence, and re-

cysts [20]. In a series of 30 patients,

the problems
drainage,

of incomplete

100% rate in our

[14-18].

accounting

not associated with catheter for the high success rates

reported in most of the

Kashyap [9] noted much faster and more complete resolution of abscess cavity after percutaneous

The

relatively

lower
needle

success aspiration

(60%)
study

of
is

of catheter earlier

drainage

percutaneous

possibly
ration
dure

related to the fact that repeated aspiwas attempted only once in cases of
to the first aspiration;
in which repeated aspirations this

studies [7, 9-1 1, 19] and also seen in our series. The only reasons for failure of percutaneous catheter drainage, as reported in some
taneous

catheter drainage than after percutaneous needle aspiration. However, the results of our study suggest that although mitial collapse earlier of the abscess undergoing cavity is achieved drainin patients catheter

nonresponse studies,

procewere

of the earlier
drainage (this

series
problem

[10,
can

19], have

is in contrast

to that in most of the other

been either thick pus not amenable

come
premature

to percube over-

age than in those undergoing needle aspiration, the time needed for total resolution of the
abscesses is similar in the two groups. have been
(12%

done up to three or four times [9, 14, 15, 17, 18]. In our study also, the success rate after
one aspiration was only 44%; it increased success if multiHowneedle of aspi[9,
5 to from

by using
removal

larger
of the

bore

catheters)
catheter

or
both

Complications

drainage

catheter

drainage

reported with in the series of

to

(strict

adherence occurred

to the criteria

60% after rate would ple repeated aspirations rations

14-18]) 14 days

two aspirations. A higher likely have been achieved aspirations (with attempted. the patients to multiple the average ranging
period

removal
recurrence Our

can prevent

this problem

for catheter [1 1]). No

Lambiase et al. [21]) and needle aspiration (4% in the series of Baek et al. [14]). Baek et al. and Giorgio lower incidence
as one

in any of our cases dur-

et al. [15]

describe

the much
with

were

ing the follow-up

study

period.
no meaningful differ-

of complications
of the major

percu-

ever, subjecting
per patient
over [14-17]

suggests

taneous
drainage

needle aspiration

than with

catheter
of

number
varying

from

1.4 to five

ence in either the time taken for defervescence or the duration of hospitalization among the
patients successfully treated with either tech-

advantages

a short

needle aspiration. However, our study and some recent reports suggest that both procedures,
safe if properly performed, are essentially

is a traumatic

and unpleasant

experience
ceptable

tempts
14-18].

for the patients and may not be acto many. Moreover, even multiple atdo not guarantee a 100% cure rate [9,
For

nique. In keeping with the findings of earlier reports [7, 9-1 1, 14-19], both treatment techniques resulted in rapid clinical relief, with
most patients showing resolution of fever, local symptoms, of the procedure.

procedures with minimal [5, 7-15]. Singh and Kashyap

15%

complications [9] reported bacterial conaspirations;

incidence
after

of secondary
multiple needle

these

reasons,

we

preferred aspiration.

to

and leukocytosis

within

3 days

tamination

subject drainage

the patients
after failure

to percutaneous
by second

catheter

however, countered bacterial possibility complication abscesses

other this infection with

workers problem.

[14-1

8] have not ensecondary theoretic this in liver catheter, reported

The average size of the abscess in our study was larger than in other series 14, 15, 18]. In

contrast

to some the ultimate abscesses

of the earlier outcome are more

reports

that show

that the initial size of the abscess cavity did not

affect

[15, 16], we believe difficult to evacurenecessitating

The average hospital stay ( 1 1 days) of the who underwent percutaneous catheter drainage in our study was shorter than that reported in two earlier series [7, 19]. One possible explanation is that all the patients in those series had pyogenic liver abscesses and
patients
continued to be hospitalized for the definitive

Although a distinct

remains

an indwelling

has been rarely [7, 9-1 1, 19]. of our study

One limitation

is that the pa-

that large
peated

tients included
with abscesses

formed
of both

a heterogeneous
amebic

group

ate completely abscesses neous

in one attempt,

treatment

of the predisposing

conditions

such

and pyogenic

aspirations. The average volume of in the 10 patients in whom percutaneedle aspiration larger was unsuccessful volume
responded who

as diverticulitis, cinoma, and

gall stones, gall bladder carso forth even after removal of

causes existing in both groups. Also, many abscesses (n = 19) were of indeterminate cause. Because our institution is a referral many of these patients had been treated counts study. had this of these with antibiotics and antiamebic hospital, partially drugs

was of

catheter and resolution

No such predisposing
nized

of the abscess [7, 19].

conditions were recog-

significantly

than the average

the abscesses in the 15 patients to one or two aspirations.

One important reason for

failure

of needle

aspiration

is the inability viscous

to completely

evacu-

ate the thick

pus that may be present

in some of the abscesses [9, 15]; this pus was seen in three of our patients. Rapid reaccumulation another and seen In some of the abscess after needle aspiration is

in the small number (n = 1 1) of patients with proven pyogenic liver abscesses encountered in our study. The shorter hospital stay could also be related to the fact that, unlike the practice in previous studies, we did not wait for total radiologic resolution of abscess cavity before discharge; the average volume

before being referred

for the high

to us; this probably

percentage researchers [10, 17]. Hence,

ac-

of abscesses

with negative
Some cases This

findings
previous does

on pus cultures
have

in our
also analysis

experience outcome

of abscess Also, with

at the time of discharge

was 70 ml.

successful
scesses. from

not allow prediction of a based on the cause of abcould be obtained a larger

cause.

problem,

described

by Dietrick

[17]

in 12 of our patients of the patients (two

after first aspiraaspiration. in our series), this due to biliary no existed, and the

tion and eight patients rapid refilling

communication; obvious continuing

after second
been

could have
however,

in most patients

four of our patients were discharged catheters in situ when they became clinically stable but had persistent drainage from the catheter. The time required for complete sonographic resolution of abscess cavities after
percutaneous treatment

information

a prospective
abscesses

study that included

of a single

number of
needle

In conclusion, aspiration

although and

both

percutaneous drainage are

catheter

predisposing

factor

ranges

from

2 weeks

sale methods for the nonsurgical liver abscesses, catheter drainage

treatment
is more

of
ef-

inflammatory process itself probably contributed to the reaccumulation of fluid.

to 9 months [9, 18]. In fact, total resolution may not occur, and small residual cavities

fective

than needle aspiration,

attempts, is associated

which,
with

if lim-

ited to two

a high

1038

AJR:170, April 1998

Percutaneous

Treatment

of Liver

Abscesses

failure

rate, especially with thick

in large viscous

abscesses pus.

and

4.

Satani
provement

in abscesses

However,

B, Davidson ED. Hepatic abscesses: in mortality with early diagnosis

Am J Sung 1978:135:647-650

imand DC.

genic hepatic abscess: ment. Am Sung 1995:61 14. Back SY. Lee

results of current :407-41 1 percutaneous

manage-

the results also with appropriate many

patients,

indicate that antimicrobial

result in

needle aspiration therapy will, in

Also, among

treatment.

MG, Cho KS, Lee effectiveness

SC, Sung aspiration

KB,
of
AiR

5. GerzofSG,

JohnsonWC,

Robbins

AH, Nabseth

Auh YH. Therapeutic

hepatic abscesses: 1993; 160:799-802 15. Giorgio A, Tarantino genic abscesses: percutaneous needle liver

a cure.

Intrahepatic pyogenic abscesses: treatment by percutaneous drainage. Am JSurg 1985:149:487-494

6.

in 25 patients.

the successfully
difference tion, abscess
exists

treated patients, no significant

in the time required for clini-

Lee JF, Block

GE. The changing

clinical

pattern

of

L, Marmniello

N. et al. Pyo-

cal improvement, and the time cavity

the duration needed in the two

of hospitalizaof the groups. to treatment

hepatic abscesses. Arc-h Sung 1972:104:465-470 7. Artar B, Levendoglu H, Cuasay NS. CT-guided percutaneous aspiration and catheter drainage pyogenic liver abscesses. Am J Gasimenteml
of

13 years of experience in aspiration with US guidance. HW. PyoArch Surg

for resolution

Radiology

16. Stain genic

1995;l95: 122-124 SC. Yellin AE, Donovan AJ, Brien liver abscess:

Unfortunately,

our data do not allow us to prelikely to respond

1986;8:550-555
8. Seeto change
Medicine

modem
with

treatment.

RK,

Rockey

DC.

Pyogenic

liver and

abscess: outcome. of ame-

dict the type of abscesses

in etiology,

management.

1991:126:991-996 17. Dietrick RB. Experience

Surg 1984:147:288-291

liver abscess.

Am

needle aspiration
randomized ration cally alone address studies

alone. Further
investigating warranted

prospective,
needle aspito specifi-

9. Singh

1996:75:99-I 12 JP, Kashyap A. A comparative catheter drainage

evaluation

are therefore this problem.

percutaneous

for resistant

18. Giorgio guided

tmintest 19.

A. Amoroso percutaneous tool

Radio!

P. Francica G, et al. Echopuncture: a safe and valuable liver abscess.

Gas-

bic liver abscesses. Am J Surg 1989;l58:58-62 10. vanSonnenberg E. Muller PR, Schiffman results
ogv

therapeutic HR. et al. Bertel

for amebic 1988;l3:336-340

Intrahepatic amebic abscesses: indications for and of percutaneous catheter drainage. Radio!1985:156:631-635 VA, Agarwal DK, Baijal 55, et al. Percucatheter drainage of amoebic liver ab1992:45:187-189 D, Ambroseui P. Khoury review
Surg Gyneco!

CK, vanHeerden JA. Sheedy PF II. Treatment of pyogenic hepatic abscess. Arch Sung
1986;121:554-558

References
1 . Thompson abscess: 2. Sherlock
.cv.cIen:.

JE, Forlenza a therapeutic S. DooleyY.

9th ed. Oxford:

S, Verma approach.

R. Amebic
Rev Inftct

liver
Dis

I I. Saraswat taneous

20.

RaIls PW, Quinn

MF, Boswell

WD Jr, Calletti

PM.

1985:7:171-179
Disease

scesses. C/in Radio! 12. Robert JH, Miresew Greenstein treatment

Obstet

Radin DR. Halls J. Pattern of resolution in successfully treated hepatic amebic abscess: sonographic
evaluation. 21
.

G,

Radiology

1983;l49:541-543 L Cronan L Cronan JJ, Dorfdrainage of 335 consecutive drainage 167-179 with I -year 1992;l84:

of the liver and

1993:471-502

btharv

Blackwell,

Al. Rohner A. Critical of pyogenic liver abscess. R, Broniatowski

of the

Lambiase RE, Deyoe man GS. Percutaneous abscesses: results

Radiology

3. Theron

P. Surgical

aspects

ofamoebiasis.

BrMedJ

1947:2:123-126

1992;l74:97-l02 13. Hashimoto L. Hermann

of primary

5G. Pyo-

follow-up.

AJR:170, April 1998

1039