腎和後腹腔膿瘍：超音波及電腦斷層攝影之診斷和處置

Renal and Retroperitineal Abscesses: Ultrasonography and Computed Tomography for Diagnosis and Management

黃建鐘(Jeng-Jong Huang) ； 陳俊旭(Jean-Shen Chen) ； 楊振典(Chen-Den Yang) ； 楊文宏(Wen-Hrong Yang) ； 唐一清(Yat-Ching Tong) ； 俞芹英(Chin-Yin Yu)

《中華放射線醫學雜誌》 14卷4期 (1989/12) Pp. 315-323

摘要

Renal & retroperitoneal abscesses are rare & life-threatening infections, that may present diagnostic & therapeutic problems. Their onsets are insidious, and symptoms highly variable. Unrecognized & untreated abscess results in high morbidity & mortality. We present our recent experience of 12 patients with renal or retroperitoneal abscesses, proved by bacteriology &/or surgery. We put emphasis on the clinical manifestations, predisposing factors, bacteriology & findings of abdominal X-ray, ultrasonography & computed tomography. A review of the literature is also presented.
If a pyelonephritis patient with history of diabetes mellitus, urinary tract obstruction or urolithiasis is unresponsive to antibiotic therapy, and presents with leukocytosis, anemia, azotemia, pyuria or hematuria, we must consider the possibility of abscess. Ultrasonography can easily detect & follow up the presence of abscess, especially during gas accumulation, and provide access route. CT can define the extension of the lesion. The diagnostic rates of abdominal X-ray, ultrasonography & CT are 50%, 83% & 92% respectively.
Effective management requires appropriate antibiotic therapy & abscess drainage. Because of easy manipulation, low morbity & less complicatin, a trial of echo-guided PCD of abscess should be performed when the percutaneous drainage fails. In our group, 8 cases received percutaneous cathter drainage (PCD), including 4 cases who required furthe surgical intervention; 6 cases received surgery. 4 cases expired, including 2 cases who refused further treatment.

關鍵字

腎膿瘍 ； 後腹腔膿瘍 ； 超音波 ； 經皮導管引流術

並列摘要

Renal & retroperitoneal abscesses are rare & life-threatening infections, that may present diagnostic & therapeutic problems. Their onsets are insidious, and symptoms highly variable. Unrecognized & untreated abscess results in high morbidity & mortality. We present our recent experience of 12 patients with renal or retroperitoneal abscesses, proved by bacteriology &/or surgery. We put emphasis on the clinical manifestations, predisposing factors, bacteriology & findings of abdominal X-ray, ultrasonography & computed tomography. A review of the literature is also presented.
If a pyelonephritis patient with history of diabetes mellitus, urinary tract obstruction or urolithiasis is unresponsive to antibiotic therapy, and presents with leukocytosis, anemia, azotemia, pyuria or hematuria, we must consider the possibility of abscess. Ultrasonography can easily detect & follow up the presence of abscess, especially during gas accumulation, and provide access route. CT can define the extension of the lesion. The diagnostic rates of abdominal X-ray, ultrasonography & CT are 50%, 83% & 92% respectively.
Effective management requires appropriate antibiotic therapy & abscess drainage. Because of easy manipulation, low morbity & less complicatin, a trial of echo-guided PCD of abscess should be performed when the percutaneous drainage fails. In our group, 8 cases received percutaneous cathter drainage (PCD), including 4 cases who required furthe surgical intervention; 6 cases received surgery. 4 cases expired, including 2 cases who refused further treatment.

並列關鍵字

renal abscess ； retroperitoneal abscess ； ultrasonography ； percutaneous catheter drainage, PCD