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Imaging-Guided Percutaneous Needle Aspiration or Catheter Drainage of Neonatal Liver Abscesses: 14-Year Experience

¹ Division of Image Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, ON M5G 1X8, Canada.
² Present address: Diagnostic Radiology, St. Mary's Hospital, The Catholic University of Korea, Seoul, 150-713, South Korea.
³ Division of Neonatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.

View larger version (119K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —24-day-old male neonate with percutaneous aspiration or drainage of postoperative hepatic abscess. Klebsiella pneumoniae and Enterococcus faecalis were sources. Under sonographic guidance, 20-gauge needle (arrow) was inserted through anterior–inferior right lobe of liver into abscess.

View larger version (122K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —24-day-old male neonate with percutaneous aspiration or drainage of postoperative hepatic abscess. Klebsiella pneumoniae and Enterococcus faecalis were sources. Contrast material injection through pigtail catheter shows pigtail within abscess in two planes, frontal (B) and lateral (C).

View larger version (123K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —24-day-old male neonate with percutaneous aspiration or drainage of postoperative hepatic abscess. Klebsiella pneumoniae and Enterococcus faecalis were sources. Contrast material injection through pigtail catheter shows pigtail within abscess in two planes, frontal (B) and lateral (C).

View larger version (119K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —11-day-old male neonate with probable (culture-negative) liver abscess or hepatic parenchymal injury secondary to umbilical venous catheter infusate. Initial supine abdominal radiograph shows umbilical venous catheter tip (arrow) projected over liver.

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —11-day-old male neonate with probable (culture-negative) liver abscess or hepatic parenchymal injury secondary to umbilical venous catheter infusate. Left lateral decubitus abdominal radiograph shows isolated mottled air shadow (arrows) in region of liver.

View larger version (155K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —11-day-old male neonate with probable (culture-negative) liver abscess or hepatic parenchymal injury secondary to umbilical venous catheter infusate. Sonograms show multicystic septated intrahepatic fluid (arrows, C) suggesting liver abscess and hepatic parenchymal injury and necrosis with or without infection and perihepatic multiseptated fluid (arrow, D) suggesting rupture of hepatic abscess or infected total parenteral nutrition into peritoneum.

View larger version (141K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D —11-day-old male neonate with probable (culture-negative) liver abscess or hepatic parenchymal injury secondary to umbilical venous catheter infusate. Sonograms show multicystic septated intrahepatic fluid (arrows, C) suggesting liver abscess and hepatic parenchymal injury and necrosis with or without infection and perihepatic multiseptated fluid (arrow, D) suggesting rupture of hepatic abscess or infected total parenteral nutrition into peritoneum.

View larger version (152K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —12-day-old male neonate with solitary multiloculated abscess. Coagulase-negative Staphylococcus and Enterobacter cloacae were sources. Initial sonogram shows large, septated hypoechoic lesion.

View larger version (131K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —12-day-old male neonate with solitary multiloculated abscess. Coagulase-negative Staphylococcus and Enterobacter cloacae were sources. Follow-up sonogram shows foci of dystrophic calcifications (arrow) at previous abscess site.

View larger version (147K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —17-day-old female neonate with history of umbilical venous catheter. (Coagulase-negative Staphylococcus and gram-positive cocci were sources.) Sonogram shows well-defined mixed echogenic lesion (arrow).

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —17-day-old female neonate with history of umbilical venous catheter. (Coagulase-negative Staphylococcus and gram-positive cocci were sources.) Late follow-up sonograms show thrombi that are calcified in umbilical vein extending to left portal vein (arrows).

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —17-day-old female neonate with history of umbilical venous catheter. (Coagulase-negative Staphylococcus and gram-positive cocci were sources.) Late follow-up sonograms show thrombi that are calcified in umbilical vein extending to left portal vein (arrows).

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