PMC3351958_01
Pyogenic infection of molare 36, showing an open root canal on x-ray.
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F1
On physical examination the patient showed normal vital signs, right upper quadrant pain on palpation and a focal pyogenic infection of molar 36 with an open root canal, which had been symptomatic for some weeks (Figure 1).
(left: 1-4): location of the 3 abscesses (A1, A2, A3) eligible for percutaneous drainage: abscess 1 (A1) already drained by the sonographically inserted catheter 1 (C1). Still undrained abscess A3. [note the right sided pleural effusion]; (right: 5-8): CT-guided insertion of catheter C2 in abscess A2.
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F2
A third 10F pigtail catheter was inserted by CT guidance (C2)(Figure 2).
Drainages in situ.
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F3
Altogether 850 ml pus were evacuated (C1: 250 ml, C2: 500 ml, C3: 100 ml)(Figure 3).
Clinical course of laboratory parameters and interventions (Note: the central venous catheter was already in place on referral of the patient).
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F4
Around the 4th day of treatment the WBC and CRP levels stopped falling (Figure 4). After removal of the pigtail catheters and the central venous line, the inflammatory parameters immediately continued dropping (Figure 4).
A: Sonography on admission, B: Contrast media sonography on day 5 after admission, C: Sonographical follow-up 10 days after discharge.
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F5
Abdominal sonography revealed an enlarged liver (cranio-caudal 156 mm; dorso-ventral 180 mm) with homogenous hyperechoic parenchyma (showing signs of hepatic steatosis) and multiple hypoechoic lesions (the biggest lesion measuring 98 x 95 x 98 mm), splenomegaly (150 x 40 mm), minimal perihepatic and perisplenic ascites, and a right-sided pleural effusion (Figure 5). Under antimicrobial treatment, catheterization of the liver abscesses and removal of the suspected causative focus - by extracting the infected molar - the infection parameters (CRP, WBC) dropped, while repeated sonographic controls showed a good regression of the abscess cavity sizes (Figure 5). Another 10 days later the patient was well, had no physical complaints, normal laboratory parameters (WBC 6 x 1000/mul, CRP 0,4 mg/dl), and further resolving findings on ultrasound investigation (Figure 5).