Image-guided percutaneous drainage of thoracic empyema: Can sonography predict the outcome?

The aim of this study was to assess the safety and efficacy of image-guided percutaneous cather ter drainage (IGPCD) of thoracic empyemas, and to corr elate the outcome of IGPCD with the pre-procedural sonographic appearance. One hundred three patients (74 males and 29 females) with thoracic empyema (age range 1 month to 70 years, median age 28 pears) underwent IGPCD. In 63 (61.17%) patients, IGPCD was the primary treatment modality; in 40 (38.84% ) patients it was used after unsuccessful intercostal chest tube drainage ( ICTD). Ultrasound was the main modality used for guidance; CT guidance was used in only 7 patients (6.8%). Eight- to 12-F pigtail catheters or 10- to 14-F Malecot catheters were used. The outcome was correlated with the prepr ocedural US appearance (anechoic, complex non-septated or complete septated ) of the empyema. The IGPCD technique was successful in SO of 102 patients. Based on the US appearance, IGPCD was successful in 12 of 13 (92.3%) patie nts with anechoic empyemas; 53 of 65 (81.54%) patients with complex I non-s eptated empyemas, and in 15 of 24 (62.5%) pa patients with complex septated empyemas. A statistical; ly significant difference (p < 0.01) was seen in the outcome of IGPCD in the three categories. Twenty-two patients required further treatment: ICTD (n = 9; 2 of them later also underwent surgery); an d surgery (n = 15). The duration of catheter drainage ranged from 2-60 days . No major complications were encountered. Percutaneous catheter drainage o f thoracic empyemas with imaging guidance ensures accurate catheter placeme nt with a high success and a low complication rate. pre-procedural US can p redict the Likelihood of success of IGPCD.