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PubMed2005

Crisis management during anaesthesia: regurgitation, vomiting, and aspiration.

BACKGROUND: Regurgitation, vomiting and aspiration may occur unexpectedly in association with anaesthesia. "Aspiration/regurgitation" was ranked fifth in a large collection of previously reported incidents that arose during general anaesthesia. These problems are encountered by all practising anaesthetists and require instant recognition and a rapid, appropriate response. However, the diagnosis may not be immediately apparent as the initial presentation may vary from laryngospasm, desaturation, bronchospasm or hypoventilation to cardiac arrest. OBJECTIVES: To examine the role of a previously described core algorithm "COVER ABCD-A SWIFT CHECK", supplemented by a specific sub-algorithm for regurgitation, vomiting and aspiration, in the management of these complications occurring in association with anaesthesia. METHODS: The potential performance of this structured approach for each of the relevant incidents among the first 4000 reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual management as reported by the anaesthetists involved. RESULTS: There were 183 relevant incidents of regurgitation, vomiting and aspiration among the first 4000 reports to the AIMS. Aspiration was documented in 96, was excluded in 69, and in 18 it could not be determined whether or not aspiration had occurred. It was considered that the correct use of an explicit algorithm would have led to earlier recognition and/or better management of the problem in 10% of all cases of regurgitation and vomiting and in 19% of those in which aspiration occurred. CONCLUSION: Regurgitation and/or aspiration should always be considered immediately in any spontaneously breathing patient who suffers desaturation, laryngospasm, airway obstruction, bronchospasm, bradycardia, or cardiac arrest. Any patient in whom aspiration is suspected must be closely monitored in an appropriate perioperative facility, the acuity of which will depend on local staffing and workload. If clinical instability is likely to persist or if there are concerns by attending staff, the patient should be admitted to a high dependency unit or intensive care unit.

Algorithms↗

PubMed2006

Aspiration rate following nonsurgical therapy for laryngeal cancer.

The aim of this study was to evaluate the aspiration rate following nonsurgical therapy, i.e. chemoradiation or radiation alone for laryngeal cancer. Modified barium swallow was performed in 43 patients who complained of dysphagia following chemoradiation (n = 22) or radiation alone (n = 21) for laryngeal cancer. Patients were selected if they were cancer free at the time of the swallowing study. Dysphagia severity was graded on a scale of 1-7. Patients were grouped according to the dysphagia severity: no aspiration (grade 1-4), and severe (grade 5-7). Mean and median dysphagia grades were 4.4/5 and 3.5/3 for chemoradiation and radiation, respectively. Aspiration occurred in 12 patients (54%) of the chemoradiation group and 7 (33%) of the radiation alone group (p = 0.13). There was a higher proportion of patients with large tumor (T3-T4) in the chemoradiation group (64%) compared to the radiation group (5%) (p = 0.0001). Aspiration is a significant source of morbidity in patients treated for laryngeal cancer with chemoradiation or radiation alone. Aspiration occurred in both groups. Although the observed difference in aspiration rates did not achieve statistical significance, the higher aspiration rate in the chemoradiation group may be due to a higher proportion of large tumors, to the additional toxic effect of chemotherapy, or to the small number of patients in both groups. Diagnostic studies such as modified barium swallow should be part of future laryngeal cancer prospective studies to assess the prevalence of aspiration as it may be silent.

Aged↗

PubMedDate not supplied

Salivary duct carcinoma. Is a specific diagnosis possible by fine needle aspiration cytology?

OBJECTIVE: To review the cytomorphologic features of salivary duct carcinoma and to evaluate the likelihood of definitive diagnosis by fine needle aspiration. STUDY DESIGN: The cytomorphologic features of two cases of salivary duct carcinoma, both occurring in the parotid gland in men over 80 years of age, were evaluated by fine needle aspiration and compared to cytologic features described in the literature. Additionally, previously reported diagnoses rendered by fine needle aspiration of salivary duct carcinomas were compiled from the cytology literature. The likelihood of arriving at a definitive diagnosis by fine needle aspiration was determined from the frequency of correct cytologic diagnoses reported in the literature. RESULTS: The most characteristic features of salivary duct carcinoma by fine needle aspiration appear to be flat sheets with a cribriform pattern and tumor cells in a necrotic background with pleomorphic, eccentric nuclei and granular cytoplasm. However, no definitive diagnoses of salivary duct carcinoma by fine needle aspiration have been recorded in the cytology literature. CONCLUSION: Because of the morphologic spectrum displayed by this tumor and the absence of definitive cytologic diagnoses in the literature to date, it is unclear whether a diagnosis of salivary duct carcinoma can be rendered by fine needle aspiration. Nevertheless, if cribriform groups are noted in a salivary gland aspirate, the diagnosis of salivary duct carcinoma should at least be considered.

Aged↗

PubMedDate not supplied

Diagnosis of parasites in fine needle breast aspirates.

OBJECTIVE: To document the value of fine needle aspiration cytology (FNAC) in the diagnosis of parasites in breast aspirates. STUDY DESIGN: Review of 8,364 breast aspirates studied over 15 years (1978-1992) for parasitic infections. RESULTS: Eight cases of cysticercosis and nine of filariasis were detected among 4,714 benign breast aspirates. Diagnosis of cysticercosis was based on identification of parts of the parasite in aspirates (seven cases) and excisional biopsy (one case). Among the cases of filariasis in breast aspirates, gravid adult females of Wuchereria bancrofti were seen in three cases and microfilarial larvae in four. In the remaining two cases, an intense, eosinophilic infiltrate was seen in breast aspirates, while microfilariae were identified in aspirates from draining axillary lymph nodes. CONCLUSION: In rare cases, parasitic infections present as breast lumps and can be easily diagnosed by FNAC.

Adolescent↗

PubMed2002

Manual aspiration versus chest tube drainage in first episodes of primary spontaneous pneumothorax: a multicenter, prospective, randomized pilot study.

Although there is no agreement on the optimal treatment of patients presenting with a first episode of primary spontaneous pneumothorax, the majority of physicians prefer chest tube drainage for air evacuation. Manual aspiration of air has been proposed by some, but lack of sound comparative data and safety data has limited its use. In this first randomized, prospective, multicenter pilot study, 60 patients with a first episode of primary spontaneous pneumothorax were randomly allocated to manual aspiration (n = 27) or chest tube drainage (n = 33). Immediate success was obtained in 16 out of 27 (59.3%) in the manual aspiration group, and in 21 out of 33 (63.6%) in the chest tube drainage group (p = 0.9). One-week success rates were 25 out of 27 (93%) in the intention-to-treat manual aspiration group and 28 out of 33 (85%) in the chest tube drainage group (p = 0.4). Fourteen of 27 manual aspiration patients (52%) were hospitalized, versus 100% of the chest tube drainage patients (p < 0.0001). Recurrence rates with at least 1-year follow-up were 7 out of 26 (26%) in the manual aspiration group, and 9 out of 33 (27.3%) in the chest tube drainage group (p = 0.9). There were no complications associated with manual aspiration. Although statistical power is insufficient to formally confirm therapeutic equality, this pilot study suggests that in first episodes of primary spontaneous pneumothorax, manual aspiration seems equally effective as chest tube drainage and is safe, well tolerated, and feasible as an outpatient procedure in the majority of patients.

Adolescent↗

PubMed1988

Use of ultrasound localization to improve results of fine needle aspiration cytology of breast masses.

A prospective randomized controlled trial of 116 patients with breast masses was conducted to compare the accuracy of 'blind' aspiration cytology performed in the clinic with aspiration cytology using ultrasound localization. The unsatisfactory aspiration cytology rate was significantly reduced by ultrasound localization (P = 0.028). This was mainly due to an improvement in the unsatisfactory rate for tumours less than 3 cm in diameter (P = 0.036). The results were influenced by the number of needle manoeuvres performed, less than 10 needle manoeuvres being associated with a 54% unsatisfactory aspiration rate compared with 25% when greater than 10 manoeuvres were performed (P = less than 0.02). One experienced aspirator in the clinic had results comparable to those achieved with ultrasound localization. It is concluded that experience and technique are the most important factors in obtaining a satisfactory aspirate from breast masses. Routine ultrasound localization prior to aspiration confers some benefit. Consideration should be given to the use of the ultrasound-assisted technique following a previous unsatisfactory aspiration, particularly if the tumour is less than 3 cm in diameter.

Biopsy, Needle↗

PubMed2004

Interleukin (IL)-1 beta in tracheal aspirates from premature infants induces airway epithelial cell IL-8 expression via an NF-kappa B dependent pathway.

Tracheal aspirate IL-8 concentration and airway epithelial cell IL-8 expression are each increased in premature infants undergoing mechanical ventilation. We sought to determine the cytokines responsible for IL-8 expression in this context. Tracheal aspirates were collected from 18 mechanically ventilated premature infants. IL-8 protein abundance was high in tracheal aspirates from ventilated premature infants (mean, 5806 +/- 4923 pg/mL). IL-1 alpha (mean, 20 +/- 6 pg/mL), IL-1 beta (mean 67 +/- 46 pg/mL), and tumor necrosis factor (TNF)-alpha (mean, 8 +/- 2 pg/mL) were also found. Incubation of tracheal aspirates with 16HBE14o- human bronchial epithelial cells increased IL-8 protein in both cell lysates and supernatants, as well as transcription from the IL-8 promoter. Aspirates also induced nuclear factor (NF)-kappa B activation. Mutation of the IL-8 promoter NF-kappa B site abolished aspirate-induced IL-8 transcription. Endotoxin concentrations in the tracheal aspirates were negligible and incapable of inducing IL-8 promoter activity. Finally, incubation of tracheal aspirates with a neutralizing antibody against IL-1 beta reduced epithelial cell IL-8 production, whereas neutralizing antibodies against IL-1 alpha and TNF-alpha had no effect. We conclude that airway fluid from mechanically ventilated premature infants contains soluble factors capable of inducing airway epithelial cell IL-8 expression via a NF-kappa B-dependent pathway, and that IL-1 beta plays a specific role in this process.

Cells, Cultured↗

PubMed1991

Percutaneous aspiration of brain tumor cysts via the Ommaya reservoir system.

We performed percutaneous aspiration of 21 brain tumor cysts in 20 patients using the Ommaya reservoir system. Ages ranged from 3 to 70 years, median 48. Sixteen were primary tumors (12 anaplastic glioma, 2 craniopharyngioma, 1 oligodendroglioma, 1 brainstem glioma) and 4 were metastatic. Fourteen had the CT appearance of a true cyst and 7 a pseudocyst. We placed 18 catheters through twist drill holes via CT stereotactic guidance and 3 through burr holes via CT guidance and effectively aspirated 3 to 50 ml cyst fluid from 1 to 18 times in each patient. Postaspiration CT showed complete or significant reduction in cyst size in all patients in whom it was performed (18 after initial aspiration and 9 after subsequent aspirations). Asymptomatic intracyst hemorrhage occurred in 2 patients after cyst wall biopsy and catheter placement. There have been no other complications at follow-up of 4 to 114 weeks. In our experience, tumor cyst aspiration by the Ommaya reservoir system is as effective as percutaneous needle aspiration, but after catheter placement aspiration can be performed with minimal technical skill, avoiding repeated CT guidance required for needle aspiration of recurrent deep-seated cysts.

Adolescent↗

PubMed2001

Assessment of aspiration risk in stroke patients with quantification of voluntary cough.

BACKGROUND: Dysphagia and subsequent aspiration are serious complications of acute stroke that may be related to an impaired cough reflex. It was hypothesized that aspirating stroke patients would have impaired objective measures of voluntary cough as compared with both nonstroke control subjects and nonaspirating stroke patients. METHODS: Swallowing was evaluated by standard radiologic or endoscopic methods, and stroke patients were grouped by aspiration severity (severe, n = 11; mild, n = 17; no aspiration, n = 15). Airflow patterns and sound pressure level (SPL) of voluntary cough were measured in stroke patients and in a group of normal control subjects (n = 18). Initial stroke severity was determined retrospectively with the Canadian Neurological Scale. RESULTS: All cough measures were altered in stroke patients as a group relative to nonstroke control subjects. Univariate analysis showed that peak flow of the inspiration phase (770.6 +/- 80.6 versus 1,120.1 +/- 148.4 mL/s), SPL (90.0 +/- 3.1 versus 100.2 +/- 1.6 dB), peak flow of the expulsive phase (875.1 +/- 122.7 versus 1,884.1 +/- 221.6 mL/s), expulsive phase rise time (0.34 +/- 0.1 versus 0.09 +/- 0.01 s), and cough volume acceleration (5.5 +/- 1.3 versus 27.8 +/- 3.9 mL/s/s) were significantly impaired in severe aspirators as compared with nonaspirators. Aspirating patients had more severe strokes than nonaspirators (mean Canadian Neurological Scale score 7.7 +/- 0.7 versus 9.8 +/- 0.3). Multivariate logistic regression found only expulsive phase rise time values during cough correlated with aspiration status. CONCLUSION: Objective analysis of cough may provide a noninvasive way to identify the aspiration risk of stroke patients.

Aged↗

PubMed1993

Glucose in epidural catheter aspirate.

Frequently fluid may be aspirated from epidural catheters during epidural anesthesia/analgesia. This fluid may be either cerebrospinal fluid or local anesthetic. Several methods for differentiation of the two fluids have been recommended. In this study, the reliability of the "glucose test" was analyzed. Epidural catheters were inserted into 43 healthy, nondiabetic parturients and then gently aspirated. Aspirate was tested for glucose using glucose oxidase paper. Positive aspirates were assessed for the presence of prealbumin, which is a protein marker for cerebrospinal fluid. Of the patients undergoing cesarean section, 17 of 27 patients yielded a glucose-positive aspirate, and of the patients undergoing labor analgesia, 6 of 16 patients were found to be positive for glucose. None of these patients developed total spinal anesthesia or postdural puncture headache. Visually, none of the aspirates were significantly blood-tinged, blood being a possible source of glucose. When the glucose-positive aspirates were subjected to immunoelectrophoresis, 6 of 7 aspirates revealed a prealbumin band. In conclusion, the glucose test for cerebrospinal fluid may be misleading. The source of this glucose may be normal cerebrospinal fluid drainage into the epidural space.

Analgesia, Epidural↗

PubMed2005

Effect of the dominant follicle aspiration before or after luteinizing hormone surge on the corpus luteum formation in the cow.

Luteinizing hormone (LH) surge and follicle rupture act as trigger to start corpus luteum (CL) formation. Thus, we aimed to investigate whether a dominant follicle that has not been exposed to an LH surge can become a functional CL. For this purpose, follicular fluid from the dominant follicles (DF) of cows was aspirated before or after a GnRH-induced LH surge, and subsequent CL formation was observed. Holstein cows were divided into four groups as follows: Luteal phase, a DF was aspirated 7 days after GnRH injection; Pre-LH surge, a DF was aspirated 42 h after PGF(2alpha) injection during the mid luteal phase; Post-LH surge, a DF was aspirated 24 h after GnRH injection following PGF(2alpha); and Intact follicle, ovulation was induced by GnRH injection after PGF(2alpha). Observation of morphological changes in the aspirated follicle using color Doppler ultrasonography and blood sampling was performed on Days 0, 3, 6, and 9 (Day 0 = follicle aspiration). CL formation following DF aspiration was observed only in the Post-LH surge group. In both the Luteal phase and Pre-LH surge groups, however, none of the cows showed local blood flow at the aspirated site or CL formation. Luteal blood flow area, CL volume, and plasma progesterone concentration in the Post-LH surge group were no different from those in the Intact follicle group. The present results clearly demonstrate that rather than follicle rupture, it is the LH surge that is essential for CL formation in cows.

Animals↗

PubMed1994

Ultrasonography and ultrasound-guided fine-needle aspiration biopsy of head and neck lesions: a surgical perspective.

A head and neck ultrasound-guided fine-needle aspiration clinic was set up to determine the role of ultrasound and ultrasound-guided fine-needle aspiration in the evaluation of patients with lesions in this region. One hundred ninety-five lesions were biopsied by ultrasound-guided fine-needle aspiration in 203 patients. Ultrasound detected 2 or more lesions in 14 (48%) of 29 patients with a clinically solitary thyroid nodule. Three (8.8%) of 34 lesions thought to be within the parotid gland were determined to be external. A pronounced learning curve was evident in the technique of ultrasound-guided fine-needle aspiration, particularly for nonpalpable disease. Adequacy of sampling for each 3-month period was 71%, 89%, and 94%, respectively. Seventy-four percent of central aspirations were satisfactory compared to 54% of peripheral aspirations. Ultrasound-guided fine-needle aspiration did not alter the clinical staging of metastatic neck disease in 8 patients having 10 neck dissections but proved useful in detecting nodal recurrence in 3 irradiated necks that did not proceed to surgery. The smallest node to harbor malignancy had 4-mm maximal axial diameter. We conclude that ultrasound and ultrasound-guided fine-needle aspiration are valuable adjuncts to the clinical examination.

Biopsy, Needle↗

PubMed2006

Cough and aspiration of food and liquids due to oral-pharyngeal dysphagia: ACCP evidence-based clinical practice guidelines.

BACKGROUND: Cough may be an indicator of aspiration due to oral-pharyngeal dysphagia. METHODS: Relevant literature was identified by searching the Communication Sciences and Disorders Dome, the Cumulative Index to Nursing and Allied Health Literature, the Educational Resource Information Center, Health & Psychosocial Instruments, the American Psychological Association, and the National Library of Medicine databases from 1965 to 2004 using the terms "deglutition," "aspiration," and "cough." RESULTS: Aspiration was observed on radiologic evaluation in over one third of acute stroke patients and in >40% of patients undergoing cervical spine surgery. Cough while eating may indicate aspiration, but aspiration may be clinically silent. Subjective patient and caregiver reports of cough while eating are useful in identifying patients who are at risk for aspiration. Objective measures of voluntary cough and tussigenic challenges to inhaled irritants are under investigation to determine their capacity to predict the risk for aspiration and subsequent pneumonia. The treatment of dysphagic patients by a multidisciplinary team, including early evaluation by a speech-language pathologist, is associated with improved outcomes. Effective clinical interventions such as the use of compensatory swallowing strategies and the alteration of food consistencies can be based on the results of instrumental swallowing studies. The efficacy of swallowing exercises and electrical muscle stimulation is under study. Surgical interventions may be considered in selected patients, but studies proving efficacy are generally lacking. CONCLUSIONS: Patients who are at risk for aspiration can be identified, and appropriate interventions can reduce its associated morbidity.

Cough↗

PubMed2004

Aspiration and ingestion in dental practice: a 10-year institutional review.

BACKGROUND: This article is an institutional retrospective review of incidents involving aspiration and ingestion of dental foreign objects at a large multidisciplinary dental educational facility. It was undertaken to determine which dental procedures were more likely to involve aspiration or ingestion, as well as to evaluate the outcome of these adverse incidents. METHODS: The inclusion criteria involved all patients who were documented to have experienced loss of dental instruments or material behind the posterior pharynx during a 10-year consecutive period. The dental and medical records of these patients were analyzed, and the outcomes of the adverse events fell into three categories: aspiration, ingestion, or neither aspirated nor ingested. The authors also noted the type of dental instrument and the specialty or area of dentistry in which this event occurred. RESULTS: There were 36 documented cases. Twenty-five of these were instances of ingestion and one was an aspiration. In 10 cases, aspiration and ingestion were ruled out through radiographic examination or the object was retrieved from the patient's mouth. CONCLUSIONS: Fixed prosthodontic therapy had the highest number of incidents of adverse outcomes. Ingestion was a more prevalent outcome than aspiration. Dental procedures involving single-tooth cast or prefabricated restorations involving cementation have a higher likelihood of aspiration. CLINICAL IMPLICATIONS: The implications for clinical practice include the recognition of risk that dental therapy demands in regard to the airway and posterior pharynx, documentation and follow-up of adverse outcomes, and the use of preventive measures such as rubber dams or gauze throat screens or floss ligatures.

Cementation↗

PubMed1992

Systematic inclusion of clinical and laboratory data improves diagnostic accuracy of fine-needle aspiration biopsy in solitary thyroid nodules.

In this study, we identified clinical and laboratory markers of malignant thyroid nodules and determined whether systematic inclusion of these data could improve diagnostic accuracy of fine-needle aspiration biopsy in solitary thyroid nodules. The patients were 24 men and 105 women who underwent surgical removal of solitary thyroid nodules and had adequate fine-needle aspiration biopsy performed prior to surgery. Including fine-needle aspiration biopsy's diagnosis of suspected of malignancy in the same category as malignancy, the sensitivity and specificity of fine-needle aspiration biopsy were 71.4% and 85.1%, respectively, with an accuracy of 82.2%. Using stepwise linear regression analysis, clinical data, i.e. increasing age, irregular nodule surface, hard consistency of nodule, and high serum thyroglobulin concentration, were associated with an increased risk of malignancy when the cytological result was excluded. When cytology was also considered, male sex, irregular nodule surface and high serum thyroglobulin concentration were found to be associated with an increased risk of malignancy. The diagnostic value of clinical data alone, even in combination with cytology or laboratory data, was inferior to that of fine-needle aspiration biopsy alone. The specificity and accuracy of fine-needle aspiration biopsy could be increased to 98.0% and 90.7%, respectively, whereas its sensitivity was decreased to 64.3% when these variables were considered in combination. Therefore, of fine-needle aspiration biopsy, clinical and laboratory data, fine-needle aspiration biopsy alone has the highest diagnostic value, which can be increased only when both clinical characteristics and serum thyroglobulin concentration are systematically included.

Adult↗

PubMed1986

Fine needle aspiration biopsy: the role of immediate cytologic assessment.

Fifty-two thoracic and 89 abdominal aspiration biopsy specimens assessed immediately by microscopic examination were evaluated prospectively. These biopsies were compared retrospectively with an equal number and type of biopsies that were not assessed immediately by microscopic examination. The comparison was made to determine whether the diagnostic accuracy and the complication rates of fine needle aspiration cytology would be improved by immediate microscopic assessment. The accuracy of fine needle aspiration biopsy with and without immediate cytologic assessment for the thoracic aspirates was 92% and 85%, and for the abdominal aspirates it was 74% and 81%, respectively. The complication rates with and without immediate assessment for the thoracic aspirates was 40% and 35%, and for the abdominal aspirates it was 7% and 6%, respectively. Immediate cytologic assessment did not change the accuracy or complication rates of fine needle aspiration biopsy significantly, but we believe that it provided greater educational benefits for fellows and staff in cytopathology and interventional radiology.

Abdomen↗

PubMed1992

The role of fine-needle aspiration and pneumocystography in the treatment of impalpable breast cysts.

Prior studies have suggested that the recurrence rate is lower in breast cysts treated by pneumocystography (injection of air into cyst cavities after cyst aspiration) than in cysts treated by fine-needle aspiration alone. To determine if this is the case for impalpable breast cysts, we reviewed the hospital records and mammograms of 38 women with 41 impalpable cysts. Mammograms obtained immediately after aspiration show that pneumocystography was successful in 18 and unsuccessful in 20 of the 41 cysts. Four cysts were excluded from the study: one cyst that recurred after aspiration and was sampled by biopsy and three cysts for which immediate post-aspiration mammograms were unavailable but which had recurred or persisted 3 years after aspiration. Review of follow-up mammograms made 4 months to 3 years after the aspiration showed that three (17%) of 18 cysts in the group with successful pneumocystography recurred and 11 (58%) of 19 cysts in the unsuccessful group recurred (p = .02). No difference was found in the number of recurrent cysts in relation to estrogen therapy or menopausal status. Our results indicate that impalpable breast cysts treated by pneumocystography are less likely to recur than are cysts treated by aspiration alone.

Adult↗

PubMed1994

Treatment of pelvic abscesses and other fluid collections: efficacy of transvaginal sonographically guided aspiration and drainage.

OBJECTIVE: The purpose of this study was to evaluate the clinical efficacy of transvaginal sonographically guided aspiration and drainage of pelvic fluid collections. MATERIALS AND METHODS: Forty patients underwent transvaginal sonographically guided aspiration of a possible pelvic abscess (41 pelvic collections). In patients with clinical findings highly suggestive of infection, both purulent and nonpurulent collections were immediately drained via a catheter. In patients with clinical findings moderately suggestive of infection, nonpurulent collections were completely removed by aspiration and the aspirates were cultured; however, purulent collections were immediately drained via a catheter. RESULTS: All collections were successfully accessed by transvaginal sonography. For 27 of the 41 collections, the aspirate was purulent (18 collections) or the patient's clinical findings were highly suggestive of infection (nine collections) and catheter drainage was performed. Seventeen of the 27 collections completely resolved and surgery was not required. Four of the 27 collections were in patients who had surgery for reasons other than persistent infected collection. For six of the 27 collections, catheter treatment was not successful and surgery was required. The overall success rate of catheter drainage was 78%. In the remaining 14 of the 41 collections, the aspirate was serous or serosanguineous, and the patient's clinical findings were moderately suggestive of infection. Cultures of aspirates of seven collections were positive for microorganisms. Eleven collections were successfully treated with antibiotics or no therapy was required (based on culture results); for three, surgery was required. Two complications occurred: one vaginal fistula after catheter drainage and one disruption of vaginal sutures after aspiration. CONCLUSION: Transvaginal sonographically guided drainage is effective treatment of pelvic abscess, being either completely curative or temporizing in 78% of patients. Catheter treatment was unsuccessful and surgery was necessary in 22% of patients. For nonpurulent collections, catheter drainage is indicated only when clinical findings are highly suggestive of infection.

Abscess↗