Pelvic Biopsy and Drainage Procedures Quiz

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Questions and Answers

What is the commonest approach for pelvic biopsy or drainage in most centers?

Anterior approach

Transrectal approach

Transvaginal approach

Transgluteal approach (correct)

What imaging guidance is primarily used for pelvic procedures?

X-ray

Ultrasound

CT (correct)

MRI

Which area does gravity cause pus to collect in, making it difficult to access from an anterior approach?

Peritoneal cavity

Practical abdominal space

Anterior pelvic space

Prerectal space (correct)

Why is it important to plan the transgluteal approach as close to the sacrum as possible?

To avoid damaging the gluteal vessels and sciatic nerve Signup and view all the answers

What type of catheter is preferred for drainage in this context?

Self-retaining catheters Signup and view all the answers

What is recommended to reduce discomfort during transrectal procedures?

Cleansing enema Signup and view all the answers

Which approach is described as having surprisingly little discomfort even though it is a 'dirty' route?

Transrectal approach Signup and view all the answers

What must be done with the fluid aspirated during a drainage procedure?

Observe its color and consistency Signup and view all the answers

What is a significant risk if drainage ports are not correctly positioned within the chest?

Surgical emphysema and drain failure Signup and view all the answers

What is a commonly recommended strategy if bleeding is observed during the dilation of a tract?

Tamponade the tract by inserting the drain Signup and view all the answers

Which of the following statements about vertebroplasty is correct?

It stabilizes a collapsed vertebra using bone cement Signup and view all the answers

In the event of acute sepsis during drainage, which action is considered essential?

Prompt resuscitation with second-line antibiotics Signup and view all the answers

When is vertebroplasty typically recommended?

After simpler treatments have failed Signup and view all the answers

What is a potential complication of chest drain procedures?

Damage to neurovascular bundles Signup and view all the answers

Which condition indicates a need for vertebroplasty procedure?

Severe pain from vertebral compression fractures Signup and view all the answers

What does the prompt resuscitation for sepsis typically involve?

Providing oxygen and IV fluids Signup and view all the answers

What is a critical factor for effective needle placement during vertebroplasty?

Accurate needle placement Signup and view all the answers

Which gauge needle is typically used for lumbar and lower thoracic spine procedures?

11 gauge needle Signup and view all the answers

What benefit does vertebroplasty provide for patients?

Improved functional abilities and mobility Signup and view all the answers

What is a common complication associated with vertebroplasty?

Infection Signup and view all the answers

Which of the following is NOT a use for vertebroplasty?

Herniated disk treatment Signup and view all the answers

What is the risk of infection during vertebroplasty?

Less than 1 in 1,000 Signup and view all the answers

After vertebroplasty, a significant percentage of patients regain lost mobility. What is this percentage?

75 percent Signup and view all the answers

What can happen if orthopedic cement leaks from the vertebral body?

Usually no serious problem unless in dangerous location Signup and view all the answers

What is a primary indication for performing vertebroplasty?

Pain refractory to traditional medical therapy Signup and view all the answers

Which medication should be avoided before the vertebroplasty procedure?

Orange juice or milk Signup and view all the answers

What type of fracture is NOT a direct indication for vertebroplasty?

Stable compression fractures Signup and view all the answers

What is one possible patient condition that could qualify them for vertebroplasty?

Patients experiencing mobility issues due to pain Signup and view all the answers

What type of fracture might require vertebral augmentation?

Chronic traumatic fractures with non-union Signup and view all the answers

Which equipment is essential during a vertebroplasty procedure?

Hollow needle or trocar Signup and view all the answers

What is the role of polymethylmethacrylate (PMMA) in vertebroplasty?

To stabilize and strengthen the vertebrae Signup and view all the answers

Which symptom is characteristic of fractures that may be treated with vertebroplasty?

Pain that worsens with weight bearing Signup and view all the answers

What is the purpose of using fascial dilators during catheter placement?

To create a track larger than the drainage catheter Signup and view all the answers

What is the recommended imaging technique for subphrenic abscess drainage?

Ultrasound and fluoroscopy Signup and view all the answers

Which of the following is NOT a recommended method for securing a catheter to the patient?

Using rubber bands Signup and view all the answers

What complication should be included during consent for potential risks of subphrenic abscess drainage?

Empyema Signup and view all the answers

When dealing with upper abdominal solid organ abscesses, what is a common imaging guidance method?

Ultrasound guidance Signup and view all the answers

What might be a reason for caution when using an intercostal approach for drainage?

Adhesion of the pleural surface Signup and view all the answers

For which of the following conditions is drainage likely to be performed less commonly under ultrasound guidance?

CT scan for pericolic abscesses Signup and view all the answers

Which abscess is often associated with pancreatitis complications?

Peripancreatic abscess Signup and view all the answers

What is the primary purpose of vertebroplasty in patients with osteoporosis?

To repair a known, non-healing compression fracture Signup and view all the answers

Which patient group is generally not recommended for vertebroplasty due to limited experience?

Otherwise healthy younger patients Signup and view all the answers

What is the complication rate for percutaneous vertebroplasty when treating malignant neoplasms?

7 to 10 percent Signup and view all the answers

Which of the following complications is associated with vertebroplasty but occurs at a rate of less than 1 percent?

Need for decompressive surgery Signup and view all the answers

Which imaging method is best for evaluating the age of a fracture?

History of the injury Signup and view all the answers

What is a common complication experienced shortly after vertebroplasty due to cement polymerization?

Worsening of pain Signup and view all the answers

For which condition would vertebroplasty likely be a poor choice due to the patient's positioning during the procedure?

Severe emphysema Signup and view all the answers

What imaging technique is used to visualize the cement filling in the fractured vertebral body post-injection?

CT scan Signup and view all the answers

Study Notes

Joint Injection and Vertebroplasty Procedures

Joint injections are used to treat pain in joints.
Vertebroplasty is a nonsurgical procedure to stabilize collapsed vertebrae.
Interventional radiologists perform both procedures using imaging guidance.

Aspiration/Drainage

Diagnostic aspiration is used when the nature of a collection is unclear, or when a small collection is difficult to drain.
It is used to assess collection content (thin vs. thick fluid, pus) and provides bacterial sensitivity.
A 20G needle is often used, but if aspiration fails, a further puncture may be needed.
Drainage aims to leverage gravity to drain collections. The drain site should be in a dependent position, preferably below the collection level.
Ultrasound is helpful to assess viscosity, loculi, and septa of the collection.
The type and number of drains needed depend on the properties (anechoic, few scattered echoes, extensive/swirling echoes, diffuse echoes with gas)

Drainage Catheter Selection

6-8Fr catheter for clear fluid
8-10Fr catheter for thin pus
10-12Fr catheter for thick pus
12-22Fr catheter for collections with debris

Procedure (Aspiration/Drainage)

The chosen catheter's technique is followed.
Prepare and anesthetize skin and puncture site.
Create a sufficient skin incision for catheter insertion, using imaging guidance.
A guidewire is placed into collection.
The tract is dilated (1-2Fr larger than drainage catheter).
A guidewire is securely fixed to avoid kinking.
Attach the drainage catheter stiffener to the guidewire.
Securely fix the catheter.
Attach the catheter to the patient using sutures, adhesive systems, or waterproof tape.
Placement should be practical and comfortable.

Specific Site Considerations (e.g., Subphrenic Abscess)

Subphrenic collections are often postoperative.
These collections are in inconvenient locations (below pleural reflection)
Combine ultrasound and fluoroscopy for approach planning.
Intercostal approach is sometimes an option to avoid the pleura.
Potential complications (e.g., empyema) should be discussed during consent.

Upper Abdominal Solid Organ Abscesses

Liver, renal, and splenic abscesses can be drained percutaneously.
Success rates typically around 90%.
Ultrasound and sometimes CT guidance is common.
Drainage of complications like peripancreatic abscesses, pseudocysts, and phlegmons is frequent.
Vascular organs (spleen) require smaller catheters.

Pericolic Abscess

These (often secondary) result from diverticular, periappendiceal, or postoperative collections.
CT guidance is essential.
Care to avoid puncturing adjacent loops.
Further follow-up imaging is usually with CT.

Pelvic Collections

Difficulty in identifying a route that doesn't impact bowel or bladder.
Collections often reside in the prerectal space (gravity).
Transrectal, transvaginal, and transgluteal approaches are options, with transgluteal being most frequent.

Transvaginal Approach

Lithotomy position for the patient.
Sedation is often recommended.
Vaginal wall can be difficult to traverse.
Vagina and perineum are cleaned with povidone iodine solution.
Catheters up to 12Fr can be used, requiring serial fascial dilators over a stiff guidewire.

Pancreas Procedures

Peripancreatic abscesses, pseudocysts, and phlegmons are common.
Collections (lesser sac) can usually be approached from the anterior through the transverse mesocolon.
Left paracolic gutter abscesses and need CT guidance.
Frequent CT scans may be needed (e.g., follow-up).
Large pseudocysts can be treated by cyst gastrostomy.

Intercostal Chest Drains

Used to remove fluid or air from the pleural space.
Common indications include pneumothorax (simple or tension), pneumothorax in patients with chronic lung disease, pleural effusion, or hemothorax.

Optimum Drain Position

Position of the drain depends on why it was inserted.
Pneumothorax: Towards lung apex.
Pleural fluid drainage: Towards cardiophrenic border.

Bilateral Chest Drains

Bilateral chest drains are used for multiple pneumothoracies.
Surgical emphysema may be present.
The left drain may require withdrawal.
Pneumothorax is often not visible on chest x-ray.

Problems with Chest Drains

Pain
Damage to neurovascular bundles
Trauma to liver, spleen, lungs
Need proper drainage port placement.
Surgical emphysema and drain failure can be a complication.

Complications (general)

Acute sepsis requires broad-spectrum antibiotics.
Prompt resuscitation is essential.
Liaison with the clinical team is important.
Monitor pulse and blood pressure during procedure.
CT scans are helpful for planning further therapy such as arterial embolization.

Vertebroplasty

Purpose is to stabilize fractured vertebrae, improving pain and preventing collapse.
Treatment for vertebral compression fractures that don't respond to simpler treatments.
Interventional radiologists typically perform the procedure on an outpatient basis.

Vertebroplasty - Indications

Painful osteoporotic fractures within the last year.
Refractoriness to traditional pain management.
No long-term pain relief from analgesic medications.
Significant pain interfering with daily activities.
Pain related to benign or malignant tumor.
Patient needs the procedure, given many compression fractures.

Vertebroplasty - Procedure

X-ray equipment, a hollow needle (trocar), orthopedic cement, barium powder, and a solvent are used.
The specific technique is given, using imaging guidance.
Inject cement into weakened vertebrae, strengthening them and lessening risk of fracture.
The cement hardens quickly (typically within 20 minutes).
Post-procedure pressure and bandage and possible CT scan to check distribution are needed.

Vertebroplasty - Setup and Performance

The skin near fracture site is prepped and draped.
Local anesthetic is injected nearby the fracture site.
Using x-ray guidance, a trocar is passed through the spinal muscles to precisely position the trocar within the fractured vertebra.
Cement is injected within the fractured vertebra.
Pressure is applied to control any bleeding.
An intravenous IV is used for sedative medication.

Vertebroplasty - Benefits

Increases functional abilities
Returns to previous activity levels without therapies
Prevents further vertebral collapse
Usually provides immediate and significant pain relief.
Many patients become symptom free

Vertebroplasty - Limitations

Not for herniated discs or arthritic pain.
Limited use in younger, otherwise healthy individuals.
Not for correcting pre-existing spine curvature.

Vertebroplasty - Risk

Possible complications: Infection (rare).
Orthopedic cement leakage.
Pain, neurological symptoms.
Paralysis (rare).
Allergic reactions to contrast material if used in procedure.

Radiology for Vertebral Augmentation Procedure

Plain films
MRI(Low Signal T1, High signal T2): Indicator for age is the history.

Troubleshooting - Transpedicular Approach

Trajectory (Too Steep): Final placement will be anterior and on near side.

Needle Positioning and Placement

Accurate needle placement is essential for successful cement injection and reduces complications.
Use high-quality fluoroscopy imaging.
Safest approach is transpedicular (often bilateral).

Other Notes

Appropriate patient positioning is critical.
The location of the procedure, and appropriate time are also crucial for effectiveness.

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Description

Test your knowledge on pelvic biopsy and drainage techniques with this quiz. Explore common approaches, imaging guidance, complications, and management strategies for pelvic procedures. Perfect for medical students and professionals looking to refresh their understanding.