Sivasubramanian Srinivasan MD, FRCR, Presenter: Nothing to Disclose

Hui Seong Teh MBBS, Abstract Co-Author: Nothing to Disclose

Manickam Subramanian MD,FRCR, Abstract Co-Author: Nothing to Disclose

Our aim was to compare the effectiveness of percutaneous needle aspiration with percutaneous catheter drainage in the management of liver abscess caused by Klebsiella pneumonia.  

64 patients (42 males, 22 females: 25-85years, mean 74years) with culture proven Klebsiella liver abscess underwent either percutaneous needle aspiration (n=28, size 3-10cm, mean 7.2cm) or catheter drainage (n=36,size 3-15cm, mean 9.5cm) along with appropriate antibiotic treatment. The abscesses were graded into four grades according to the liquefaction and loculations (grade1-unilocular abscess , 4 – solid appearing complex abscess with scanty liquefaction). In grade4 abscesses, percutaneous aspiration was performed with 18G needle in multiple locules to aspirate the contents. For catheter drainage, 8- to 12-French catheters were inserted into the abscess cavity by the Seldinger technique under imaging guidance. Outcome was assessed with clinical and lab parameters and sonographic monitoring of size of the abscesses. 

 Percutaneous procedures were technically successful in all patients (64/64,100%) and clinical success was achieved in 62 patients (62/64,96%). Percutaneous needle aspiration was successful in first attempt in 22 (22/28,79%) patients after one aspiration and six patients(21%) needed a second procedure where as 12(12/36,33%) patients in the drainage group needed a second procedure. Then need for second procedure, especially in grade 4 abscesses was significantly lower in the aspiration group (p<0.05) compared the drainage group. Four patients with air forming Klebsiella liver abscess, were hemodynamically unstable due to septic shock had to undergo catheter drainage and one (1/4,25%) of them could not recover from the septic shock.  

Rercutaneous aspiration is more effective in Klebsiella abscesses with scanty liquefaction compared to catheter drainage. However emergent catheter drainage is necessary in patients with air-forming Klebsiella abscesses who usually present with hemodynamic instability due to septic shock.  

In Klebsiella pneumonia liver abscesses, especially in cases with scanty fluid component, needle aspiration can be considered as a first line of management with antibiotic coverage. However in patients with air-containing Klebsiella pneumonia abscesses, emergent catheter drainage will be necessary because of severe sepsis.  

Srinivasan, S, Teh, H, Subramanian, M, Image-guided Needle Aspiration versus Percutaneous Catheter Drainage in the Management of Complex Pyogenic Liver Abscesses Caused by Klebsiella Pneumonia.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14016408.html