Learning objectives
To review the imaging findings,
indication criteria,
procedures and techniques of radiological interventions in infective pulmonary,
pleural and mediastinal diseases.
When,
why and how should a general/thoracic radiologist act?
Background
• Lung
FNAB of bacterial infections
Pyogenic pulmonary abscess drainage
Fungal infections: FNAB and treatment
• Pleura
Management of pleural effusion
Thoracentesis
Drainage
Pleural biopsy
• Mediastinum
Pericardiocentesis
Mediastinal abscess drainage
Findings and procedure details
Bacterial infections
FNAB can change treatment plan in cases of non-responsive pulmonary infections
Determination of fungal or bacterial DNA/RNA in the sample obtained by percutaneous FNAB can be helpful in immunocompromised patients
Fig. 1 Fig. 2
Nodular lung infections
In some cases,
pulmonary infections can manifest as solitary or multiple nodules
Percutaneous image-guided biopsy can be helpful in these cases
It is indicated to perform more than one sample to increase the accuracy of the procedure
Fig. 3
Pyogenic pulmonary abscess
In the modern medical...
Conclusion
Percutaneous biopsy or FNAB can contribute to the diagnosis in selected infectious cases
Image guided drainage of thoracic infections and fluid collections is the first election if conservative treatment fails and a good alternative of surgical treatment
Radiologists should know the indications,
technique and complications of the procedures
Ultrasound and CT should be used for guidance
– Ultrasound: technique of choice if possible
– CT: fluid collections not visible by US
References
Heffner,
John E.
et al.
Interventional Management of Pleural Infections,
CHEST,
2009;136:1148 – 1159
Ault MJ,
Rosen BT,
Scher J,
et al Thoracentesis outcomes: a 12-year experience,
Thorax 2015;70:127-132.
Rosenstengel A.
Pleural infection-current diagnosis and management.
J Thorac Dis.
2012;4(2):186-93.
Keeling,
A.N.,
Leong,
S.,
Logan,
P.M.
et al.
Cardiovasc Intervent Radiol 2008;31: 135.
C.
de Bazelaire,
et al.
CT-guided biopsies in lung infections in patients with haematological malignancies,
Diagnostic and Interventional Imaging,
2013;94(2):202-215
Wali SO.
An update on the drainage of pyogenic lung abscesses.
Ann...