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PubMed2002

Anaerobic thyroid abscess from a thyroid cyst after fine-needle aspiration.

BACKGROUND: Anaerobic abscess formation within a thyroid cyst is rare but still possible, although aerobic thyroid abscess formation in the thyroid gland after fine-needle aspiration (FNA) has been observed in immunocompromised patients. METHODS: This study describes the clinical manifestations, thyroid echography, cytologic finding, culture outcome, and treatment course of an anaerobic abscess formation within a thyroid cyst after FNA in a healthy subject. RESULTS: A 53-year-old male subject had rapid enlargement of a left thyroid cyst develop after second FNA. Frank pus was obtained through third FNA. The culture outcome was Propionibacterium acnes, which was rich in saliva and one of the pathogens causing periodontitis and gingivitis. After adequate antimicrobial therapy, the abscess gradually diminished. CONCLUSIONS: This article reported, for the first time, on the formation of an anaerobic thyroid abscess after FNA in a healthy subject. We recommended careful aseptic procedure and adequate isolation processes, such as wearing a mask to avoid an unfavorable outcome as a result of a bacterial infection.

Abscess↗
PubMed2004

Lingual abscess: diagnosis and treatment.

BACKGROUND: Lingual abscesses are very rare, and as a result, the individual surgeon usually lacks experience in the diagnosis and therapy of this entity. We present four cases of abscesses of the tongue diagnosed and treated during the past 2 years. METHODS: The medical records, films, and charts of four patients with lingual abscess were retrospectively reviewed. The clinical presentation, radiographic features, treatment, and outcome of the cases were examined. RESULTS: Diagnosis was obtained by clinical examination and CT. In all cases, we avoided incision and drainage and preferred draining the abscess and aspirating pus with a large-bore needle through the inferior surface of the tongue. All patients responded remarkably well and did not have any recurrence. CONCLUSIONS: Lingual abscesses are rare conditions. In contrast to the approach in cases of most deep neck space infections, a more conservative therapeutic approach by needle-aspiration is effective and has the advantages of not exacerbating the edema of the tongue and of avoiding airway compromise.

Abscess↗
PubMedDate not supplied

Epiglottic abscess.

BACKGROUND: Epiglottitis is more commonly seen in children less than 6 years of age, although this entity has also been well described among adults. A coalescence of infection of the epiglottis, or epiglottic abscess, has been infrequently reported in series of epiglottitis. Risk factors for epiglottic abscess include adult age at onset, diabetes, and the presence of a foreign body. METHODS: Case study. RESULTS: We present a case of a woman with a 4-day history of febrile illness, odynophagia, and an altered voice. Clinical examination and computed tomography (CT) demonstrated an epiglottic abscess. The patient underwent direct laryngoscopy, intubation, drainage of abscess, and intravenous antibiotics. CONCLUSIONS: The diagnosis of epiglottic abscess should be considered in adult patients initially seen with odynophagia and dysphonia. Principles of treatment include airway management, antibiotics, and surgical drainage.

Abscess↗
PubMedDate not supplied

Ultrasound-guided percutaneous drainage of pyogenic splenic abscesses.

This report summarizes the results of ultrasound-guided percutaneous drainage procedures in eight patients with solitary (n = 6) and multiple (n = 2) splenic abscesses. Seven patients underwent a total of 15 closed-needle aspirations with local installation of antibiotic solution. In one case, catheter drainage was performed. All patients received parenteral broad-spectrum antibiotic therapy. Seven (88%) of the eight patients with splenic abscesses recovered completely following percutaneous drainage procedures and none of these required splenectomy later. In one patient with multiple splenic abscesses, repetitive needle aspiration was ineffective, necessitating splenectomy. The only complication associated with nonsurgical percutaneous interventions was a pleural empyema that resolved with chest tube drainage (complication rate, 13%). These results and those reported in the literature indicate that pyogenic splenic abscesses can be treated effectively by (repetitive) closed aspiration technique or catheter drainage with a relatively low rate of complications. From our experience, splenectomy should only be performed in splenic abscesses that are not accessible percutaneously and in those cases with percutaneous drainage failure.

Abscess↗
PubMed2007

Comparison of CT- or ultrasound-guided drainage with concomitant intravenous antibiotics vs. intravenous antibiotics alone in the management of tubo-ovarian abscesses.

OBJECTIVE: The purpose of this study was to compare the outcome of treatment of tubo-ovarian abscesses by imaging-guided drainage and antibiotics vs. intravenous antibiotics alone. METHODS: A retrospective chart review of all patients hospitalized with a diagnosis of tubo-ovarian abscess was performed. Patients were categorized into two groups. The first group consisted of subjects treated with intravenous antibiotics alone. Patients in the second group had primary image-guided drainage with concomitant intravenous antibiotics. Treatment failures in the primary antibiotics group underwent salvage drainage when feasible. The primary outcome of interest was complete response. Secondary outcomes included need for additional treatment, duration of resolution of fever, total length of hospital stay, and complication rates. We also evaluated the effectiveness of secondary drainage in patients who failed primary antibiotic therapy alone. RESULTS: A total of 58 patients were included in the study. Fifty patients were treated primarily with intravenous antibiotics; eight patients had primary drainage, which was guided by ultrasound in all cases. Complete response was noted in 29 (58%) patients treated with antibiotics alone. All eight (100%) patients in the primary drainage group responded to treatment. Of the 21 treatment failures with primary antibiotics, two underwent surgery and 19 (90.5%) had salvage drainage with either ultrasound or computed tomographic guidance; 18 of 19 salvage drainages led to complete recovery. Subjects in the primary drainage group required shorter hospital stays and showed more rapid resolution of fever. No significant morbidity was noted as a consequence of drainage procedures. A higher failure rate for secondary drainage was noted in older patients, those with larger tubo-ovarian abscesses, and those with a history of pelvic inflammatory disease. CONCLUSION: Drainage of tubo-ovarian abscesses with concomitant intravenous antibiotics is an effective and safe treatment for the primary or secondary treatment of tubo-ovarian abscesses.

Abscess↗
PubMed1992

Preoperative ultrasonographic verification of peritonsillar abscesses in patients with severe tonsillitis.

Infection around the tonsillar region does not always mean the presence of a peritonsillar abscess although the condition of peritonsillitis without abscess formation may clinically present similarly. It is, however, of therapeutic importance to distinguish between the two conditions. Treatment for abscess is surgical: aspiration, incision and drainage or immediate tonsillectomy. In contrast, phlegmonous peritonsillitis only requires antibiotics. In order to evaluate the diagnostic implications of preoperative ultrasonography in patients referred for treatment of peritonsillar abscess, 27 consecutive patients were subjected to bilateral ultrasound examination to visualize the tonsillar region. The transducer used was placed just below the mandibular angle, pointing posteriorly and cranially. The results of this study showed that it was possible to verify the presence of an abscess in approximately 90% of the cases. We suggest that this examination be performed whenever the normal clinical examination is insufficient due to trismus, lack of patient cooperation, etc.

Adolescent↗
PubMed1985

Brain abscess in childhood.

The author review 10 years' experience in managing brain abscess in childhood: 19 cases were treated in children from 1 to 18 years old. The etiology was rhinogenic in 5 cases, congenital heart disease in 5, hematogenous in 3, traumatic in 3, postoperative in 1, and unknown in 3 cases. Brain abscesses that developed by direct spread were located nearby the source, whereas metastatic abscesses (such as cardiogenic or hematogenous) in most cases spread via the vertebral-basilar system, usually developing in the parieto-occipital regions. Four of the 5 cases with multiple abscesses were cardiogenic and one hematogenous. The most important neurological signs were paresis (10 cases) and cranial nerve involvement (10 cases). Six abscesses were sterile and 6 grew aerobic and 6 anaerobic bacteria. In one case, aerobic as well as anaerobic bacteria were found. Fifteen patients were treated preoperatively with antibiotics. The treatment was operative in 17 cases. In two cases, gravely ill on admission, no surgical treatment was given. The etiology, localization, bacteriology, surgical methods, and results in those cases are discussed.

Adolescent↗
PubMed1986

Brain abscess in children.

During that last 6 years, 100 children have been treated for brain abscess at the National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore. Of these, 69 abscesses were otogenic. The treatment included aspiration of the abscess (84% of cases) and antibiotic therapy. CT scan as a diagnostic tool was available only for a few cases in the last year. In 16% of the cases the abscess was excised. The overall mortality was 21%. Of the surviving children, 76% recovered totally. Epilepsy as a sequel occurred in 21% of the cases. The fact that mortality continues to be high is attributed to the degree of impairment of consciousness of the children at the time of admission. Early detection and successful treatment of brain abscess in children still remain a clinical challenge.

Adolescent↗
PubMed1994

Expression of basic fibroblast growth factor, nerve growth factor, platelet-derived growth factor and transforming growth factor-beta in human brain abscess.

We correlated the histopathological findings of six human brain abscesses with the expression of basic fibroblast growth factor (bFGF), nerve growth factor (NGF), platelet-derived growth factor (PDGF) and transforming growth factor-beta (TGF beta). The clinical courses ranged from 1 month to 1 year and viridans streptococcus was the major pathogen. In early abscesses, we demonstrated strong bFGF and moderate NGF and PDGF immunoreactivities in neutrophils and monocytes/macrophages infiltrating the abscess wall and in the fibrin layer lining the abscess center. In the subacute cases, growth of capillaries and fibroblasts into the fibrin layer and deposition of collagen resulted in the formation of a mesodermal layer between the abscess center and the outer gliotic layer. The proliferative non-neural cells (endothelial cells, fibroblasts and glial cells) expressed mild to strong bFGF, NGF and PDGF immunoreactivities, while strong TGF beta staining was seen in the extracellular matrix. A loss of growth factor expression and increased fibrosis was seen in the chronic case. These findings suggest that bFGF, NGF, PDGF and TGF beta produced by the continued influx of leukocytes and by the proliferating non-neural cells may mediate various steps of defense mechanisms and wound healing such as angiogenesis, fibrogenesis and gliosis.

Antibody Specificity↗
PubMed1993

Gas-forming liver abscess after transcatheter arterial embolization for hepatocellular carcinoma: report of a case.

A case of a gas-forming liver abscess developing after transcatheter arterial embolization for recurrent hepatocellular carcinoma (HCC) in a 65-year-old man is presented herein. He was admitted to hospital with fever and jaundice, following which ultrasonography (US) and computed tomography revealed a gas-containing abscess in the posterior segment of the hepatic lobe with multiple HCC. Percutaneous transhepatic drainage was performed using US. Antibiotics which were sensitive to the Escherichia coli bacteria detected in the abscess were administered both intravenously and through the drainage tube into the abscess. Four months later, the abscess had diminished and the patient was discharged after receiving percutaneous ultrasonographically guided ethanol injection therapy for the recurrent HCC.

Carcinoma, Hepatocellular↗
PubMed1981

CT studies of brain abscesses in cats.

Cerebral abscesses were produced in 56 cats by introducing staphylococcus aureus into the white matter of one cerebral hemisphere, using a stereotaxic apparatus. The cats were treated with antibiotics and/or steroids. The size and density of the inflammatory process and the abscess ring were measured on postcontrast CT scans. Differences were found depending on the stage of the abscess, but the deviation of values were too great for determining the age of the abscess from one measurement, to be able to apply proper treatment. The size and density of the abscesses were the same on CT whether the animals were treated or not. This was contrary to the clinical picture, the measurements of edema, and the histopathological studies.

Animals↗
PubMed1978

Renal abscess in children. A rare but important radiological diagnosis.

As in adults, renal abscess in children mimicks a tumoral syndrome. Renal abscess, although infrequent, should however be kept in mind because it is important to make an early diagnosis. The reason is simply that the treatment fo the two conditions is so different. Furthermore, an early accurate diagnosis avoids unnecessary investigations, such as arteriography, as well as unnecessary surgery. Four cases are reported in which the diagnosis of abscess was obtained by correlating both clinical and radiological findings. In only one case was arteriography performed and this was after treatment and it was normal. For an early diagnosis intravenous urography is of paramount importance. It shows a tumoral radiological pattern; in the context of clinical signs of suppuration (high fever, high leucocyte count and variably a urinary tract infection). The radiological findings suggest the diagnosis of abscess. On treatment the rapid regression and disappearance of the various clinical, laboratory, and radiological findings confirms the diagnosis of renal abscess.

Abscess↗
PubMed1989

Treatment of experimental brain abscess. 2. Effects of combinations of hyaluronidase with antibiotics and dexamethasone.

Brain abscess formation was studied experimentally in rats to determine the most appropriate nonsurgical treatment method by applying different combinations of hyaluronidase, dexamethasone and antibiotic sensitive to the inoculated bacteria in various stages of classical abscess development. The results showed that combined therapy with antibiotic and hyaluronidase started the day before inoculation averted the formation of brain abscess and the same therapy started after encapsulation, effectively eliminated the organisms and resolved the infection leaving a glial scar. But the same therapy, only started at the cerebritis stages, caused an increase of cerebritis. The addition of dexamethasone reduced the oedema but enhanced the cerebritis and delayed encapsulation. Though neurosurgical intervention continues to be the definitive method for eradicating the infection and preventing the pressure-related complications of brain abscess, our concept of management with hyaluronidase and appropriate antibiotic might be a new effective chemotherapeutic method of encapsulated brain abscesses in selected high-risk patients.

Animals↗
PubMed1987

Treatment by aspiration of brain abscesses.

Sixteen patients, with a total of 18 abscesses, were treated by aspiration and systemic antibiotic therapy, to which antiepileptic prophylaxis and corticosteroids were added. Diagnosis of the abscesses and monitoring of their evolution relied principally upon computed tomography; this technique was also used per-operatively when aspirating small abscesses. Bacteriological examinations were positive in all our cases and a polymicrobial flora was found in half of these. One or, eventually, two aspirations within the same week were sufficient, in most cases, to promote healing. Nevertheless, in three patients, the abscesses, however sterilized, did not show any volume reduction, probably because of adhesions to the dura mater, of a large part of the abscess surface area. One patient died from concomitant cardiac disease and one patient remained seriously disabled. Epilepsy was observed as a sequela, in six patients. This study emphasizes the role of neuroradiological and bacteriological examinations, whilst surgery may be restricted, in most cases, to a simple aspiration.

Adolescent↗
PubMed1980

Evolution of brain abscess in cats formation of capsule and resolution of brain edema.

Brain abscess evolution was studied in an experimental model in the cat correlating the computed tomographic scan appearance with intracranial pressure, brain edema and histopathological findings. Brain inflammation was produced by direct inoculation of Staphylococcus aureus into the white matter. Abscesses developed in all animals. The ring enhancement around the necrotic focus seen at an early stage after contrast-medium injection cannot be equated with capsule formation as long as the abscess diameter increased. Parallel to the acute stage of abscess, the intraventricular pressure increased due to the rising mass effect and the spreading edma. The morphological investigations revealed on the seventh day an extreme enlargement of extracellular spaces with immense amount of edema fluid, rich in protein and fibrin. Some blood vessels in the close vicinity of the abscess showed gaps within the endothelial cell layer. When encapsulation developed, ring enhancement became more homogeneous and decreased in diameter. In spite of encapsulation, a circumscribed disturbance of the blood-brain barrier persisted which was responsible for a belated resolution of edema and a slow decrease of intracranial pressure. Only therapy with dexamethasone could effect a marked change in the course of the disease.

Animals↗
PubMed1994

Factors that enhance the likelihood of successful stereotactic treatment of brain abscesses.

Successful clinical outcomes are not achieved in all patients who undergo image-guided stereotactic surgery as the initial procedure in the management of brain abscess. We sought to define those factors related to management failure, so that the initial surgical approach could be selected using preoperative clinical or imaging criteria. We reviewed our twelve-year experience in 29 consecutive patients. Twenty-two (76%) patients had drainage of abscesses with purulent centers. Seven (24%) underwent lesion biopsy for diagnosis. Twelve patients (with abscesses > 3 cm in average diameter) underwent stereotactic insertion of drainage catheters. Ten patients (34%) had adverse risk factors including immunologic suppression after prior organ transplantation, chronic steroid therapy, prior antineoplastic chemotherapy, or retained foreign body. Microbiological identification of the causative organism was obtained in 22 patients; 6 patients had positive Gram stains without growth in culture (bacteriological diagnosis = 97%). Long-term clinical evaluation (up to 8.5 years, median 3 years) confirmed disease resolution after initial single-procedure stereotactic management in 21 patients (72%). Eventual abscess resolution occurred in an additional 6 patients (21%), all of whom required multiple procedures. Five patients died of complications of their systemic disease during the follow-up period. Fifteen of the 18 (83%) surviving patients who had no associated risk factors returned to their premorbid functional capacity. Factors associated with initial treatment failure included inadequate aspiration, lack of catheter drainage of larger abscesses, chronic immunosuppression, and insufficient antibiotic therapy.

Adolescent↗
PubMed1987

Improved survival with early CT diagnosis of pancreatic abscess.

Until recently pancreatic abscess was often a lethal complication of acute pancreatitis. A major factor contributing to this high mortality has been delay in diagnosis. When combined with diagnostic needle aspiration, computed tomography (CT) has greatly enhanced the early detection of pancreatic abscesses. In the past 5 years at our institutions 23 patients with proven pancreatic abscesses were evaluated early in their clinical course by CT. In follow-up ranging from 4 months to 4 1/2 years there were only 4 deaths: a mortality rate of 17%. Many of the surviving patients had a long and protracted clinical course (mean length of hospitalization, 58 days) and reoperation for recurrent abscess or gastrointestinal complications was required in 9 patients (39%). Computed tomography proved helpful both in localizing the site of de novo or recurrent pancreatic abscess and in detecting postoperative complications. An aggressive approach to early CT scanning with diagnostic needle aspiration appears to be a factor in the improved survival of these patients.

Abscess↗
PubMed1982

Computed tomography of intraperitoneal abscesses.

Eighty-seven patients with the clinical suspicion of an intraperitoneal abscess were examined by computed tomography. In 83 of these patients CT gave true positive or true negative results in reference to the diagnosis of local intraperitoneal fluids. The final diagnosis confirmed 28 abscesses in 26 patients. Most of these abscesses were in the left subphrenic space, the right subphrenic space, the right anterior subhepatic space, and the pelvis. The morphological criteria for intraperitoneal abscesses, shown by CT, are defined. Direct signs include form, impression on nonintestinal organs, density value, gas collection, pyogenic membrane, and infiltration in surrounding tissue. Indirect signs include ascites and pleural effusion and/or pulmonary infiltration. Differential diagnostic problems of intraperitoneal abscesses are discussed.

Abscess↗