Intracavitary CEUS in the management of abdominal abscesses/fluid collection

Congress:

ECR 2019

Poster Number:

C-0180

Type:

Educational Exhibit

Keywords:

Cavitation, Education, Catheters, Abscess delineation, Ultrasound, Experimental, Interventional non-vascular, Contrast agents, Abdomen, Education and training

Authors:

G. Francica¹, A. Dell'Era²; ¹Castel Volturno, NA/IT, ²Shenzhen/CN

DOI:

10.26044/ecr2019/C-0180

DOI-Link:

https://dx.doi.org/10.26044/ecr2019/C-0180

Fig. 1: Multi-loculated Liver Abscess: CEUS before needle insertion shows multiple...

Fig. 2: Multi-loculated Liver Abscess: Needle aspiration of the largest...

Fig. 3: Multi-loculated Liver Abscess: Endocavitary injection of diluted Sonuvue:...

Learning objectives

To describe intracavitary Contrast Enhanced Ultrasound (CEUS), a promising CEUS application, providing clinical insights and a useful aid to relevant interventional procedures.

Background

The main uses of CEUS in US-guided interventional procedures are CEUS-guided biopsy and CEUS in relation to US-guided tumor ablation [1, 2, 3]. A lesser known modality is intracavitary CEUS i.e. injection of a diluted contrast solution directly in the catheter or needle to visualize the exact location of the cavity or tissue around the catheter or needle tip in a variety of pathological conditions, e.g. US-guided abscess drainage, US-guided nephrostomy, US-guided biliary interventions [4]. Despite intracavitary usage being reported, the EFSUMB panel of experts...

Findings and procedure details

By injecting 0.1-0.5ml of SonoVue in 20ml of saline through catheters or needles it is possible to demonstrate: the exact position, size, and echostructure of an abscess (multiloculated or uniloculated/quota of fluid component) (Fig. 1,2,3); communication between hepatic abscess/extrahepatic fluid collection and biliary tree (Fig. 4,5); catheter management, including evaluation of percutaneous cholecystostomy (Fig. 6) and demonstration of dislodgement/occlusion (Fig. 7,8). These data are of pivotal importance in: A) Therapeutic Approach Simple aspiration vs. catheter positioning in case of small abscess cavities. Use of single...

Conclusion

Intracavitary CEUS is a low-cost technique, due to the very low dose required, easy to use, and without complications. This particular use of CEUS is beneficial in relation to US-guided interventional procedures for abdominal abscesses/fluid collections in terms of better therapeutic approach and clinical management.

Personal information

References

Sidhu PS et al. The EFSUMB Guidelines and recommendation for the clinical practice of contrast-enhanced ultrasound (CEUS) in non-hepatic applications: Update 2017. Ultraschall in Med 2018 Francica G et al. Biopsy of Liver Target Lesions under Contrast-Enhanced Ultrasound Guidance – A Multi-Center Study. Ultraschall in Med 2017 Francica G. et al. Ablation treatment of primary and secondary liver tumors under contrast-enhanced ultrasound guidance in field practice of interventional ultrasound centers. A multicenter study Eur J Radiol 2018 Nolsøe CP et al—Contrast-Enhanced Ultrasound-Guided Percutaneous Interventions J...