Does an infected peripancreatic fluid collection or abscess mandate operation?

OBJECTIVE: To assess the treatment of peripancreatic fluid collections or abscess with percutaneous catheter drainage (PCD). SUMMARY BACKGROUND DATA: Surgical intervention has been the mainstay of treatment for infected peripancreatic fluid collections and abscesses. Increasingly, PCD has been used, with mixed results reported in the literature. METHODS: A retrospective chart review of 1993 to 1997 was performed on 82 patients at a tertiary care public teaching hospital who had computed tomography-guided aspiration for suspected infected pancreatic fluid collection or abscess. Culture results, need for subsequent surgical intervention, length of stay, and death rate were assessed. RESULTS: One hundred thirty-five aspirations were performed in 82 patients (57 male patients, 25 female patients) with a mean age of 40 years (range 17-68). The etiologies were alcohol (41), gallstones (32), and other (9). The mean number of Ranson's criteria was four (range 0-9). All patients received antibiotics. Forty-eight patients had evidence of pancreatic necrosis on computed tomography scan. Cultures were negative in 40 patients and positive in 42. Twenty-five of the 42 culture-positive patients had PCD as primary therapy, and 6 required subsequent surgery. Eleven patients had primary surgical therapy, and five required subsequent surgery. Six patients were treated with only antibiotics. The death rates were 12% for culture-positive patients and 8% for the entire 82 patients. CONCLUSIONS: Historically, patients with positive peripancreatic aspirate culture have required operation. This series reports an evolving strategy of reliance on catheter drainage. PCD should be considered as the initial therapy for culture-positive patients, with surgical intervention reserved for patients in whom treatment fails.

Perirenal lucency ("kidney sweat"): a new sign of renal failure.

OBJECTIVE: This study describes a new sonographic finding in renal failure: perirenal lucency, which we call the "kidney sweat" sign. MATERIALS AND METHODS: During 1 year at our institution, 502 renal sonograms were obtained. Sonography evaluated 330 patients with renal failure. All of the examinations were retrospectively analyzed. RESULTS: An extracapsular hypoechoic rim was present in 47 (14%) of the 330 patients with renal failure. The finding, when present, was always bilateral. The hypoechoic rim was not present in the remaining 283 patients with renal failure. Forty (85%) of the 47 patients had kidneys that were hyperechoic compared with the liver. Twenty-eight (60%) of the 47 patients had kidneys that were hyperechoic compared with the spleen. In 15 (32%) of the 47 patients, the kidneys were small. Ascites was present in 11 (23%) of the 47 patients. Of the 283 patients with renal failure whose sonograms did not show the hypoechoic rim, 76 patients had normal sonographic findings. The remaining 207 patients with renal failure who did not show the kidney sweat sign had hydronephrosis, stones, cysts, echogenic kidneys, small kidneys, or ascites. CONCLUSION: An extracapsular hypoechoic rim is found in patients with renal failure. We call this finding "kidney sweat." We believe, but cannot currently prove, that the kidney sweat sign represents edema. It is an additional sonographic finding in patients with renal failure.

Diagnostic sonography of HIV-associated nephropathy: new observations and clinical correlation.

OBJECTIVE: HIV-associated nephropathy is an important cause of morbidity that is characterized clinically by uremia and proteinuria and histologically by focal segmental glomerulosclerosis. In the largest series yet analyzed to our knowledge, we describe new sonographic findings and record the prevalence of other findings. We review the sonographic findings in a large group of HIV-infected patients. MATERIALS AND METHODS: Seventy-six consecutive HIV-infected patients underwent renal sonography. Abnormalities seen on sonography were recorded. RESULTS: Of 152 kidneys imaged, sonography showed that 30 kidneys (20%) were enlarged. Abnormal echogenicity was present in 136 kidneys (89%). Eighty-one kidneys (53%) were globular; 58 (38%) had decreased corticomedullary definition; 74 (49%) had decreased renal sinus fat; and 66 (43%) had heterogeneous parenchyma, some with echogenic striations. CONCLUSION: Our data reveal several sonographic abnormalities that have not previously been described: decreased corticomedullary definition, decreased renal sinus fat, parenchymal heterogeneity, and globular renal configuration. These new findings were found mainly in patients with advanced HIV infection.