A challenging CT-Guided Aspiration performed in a patient with ADPKD Assessment at Unico Hospital

A challenging CT-Guided Aspiration performed in a patient with ADPKD Assessment at Unico Hospital

A challenging CT-Guided Aspiration performed in a patient with ADPKD Assessment at Unico Hospital

A 57-years-old male patient came to Unico Hospital with known multicentric Pott’s spine presented with exacerbated lower back pain, fever, difficulty in walking and new-onset flank discomfort. His medical history was significant for bilateral autosomal dominant polycystic kidney disease (ADPKD).

Clinical assessment shows that despite anti-tubercular therapy, symptoms progressed. MRI revealed bilateral psoas abscesses tracking from the lumbar spine. The large, anatomically distorted polycystic kidneys posed a significant challenge like a traditional surgical drainage risked injury to renal cysts, infection of cyst fluid, and major hemorrhage. A minimally invasive, image-guided approach was imperative.

Unico Radiology team planned for an innovative Solution to address this case. CT-guided percutaneous aspiration was chosen for its superior ability to delineate a safe trajectory through the complex retroperitoneal anatomy, avoiding the enlarged kidneys and their cysts.

The Procedure (CT-Guided Aspiration):

Planning: A non-contrast CT scan meticulously mapped the abscess cavities, their proximity to the massively enlarged polycystic kidneys, bowel, and major vessels.

Navigation: Using CT fluoroscopy, a safe window was identified bilaterally. The needle trajectory for the left side was particularly carefully planned to skirt the inferior pole of the left polycystic kidney.

Aspiration: Under local anesthesia, 18G needles were advanced into the centers of the abscesses. Thick pus was aspirated (80mL right, 65mL left) and sent for microbiological confirmation.

Safety Check: Post-procedural CT confirmed effective drainage and the absence of iatrogenic injury to renal cysts or hematoma.

Outcome & Rationale:

- Immediate: Rapid defervescence and significant pain relief.

- Diagnostic: Aspirate confirmed tubercular etiology, reinforcing ATT.

- Safety & Synergy: This approach avoided the high risk of cyst rupture, bleeding, and fistulation associated with blind or surgical drainage in ADPKD. It allowed for uninterrupted medical management of both chronic conditions—ATT for Pott’s disease and ongoing nephrology care for ADPKD.

Conclusion: This case underscores CT-guided aspiration as the intervention of choice for psoas abscess drainage in patients with complex retroperitoneal anatomy, specifically ADPKD. The precision of CT navigation is critical to avoid catastrophic complications, demonstrating essential multidisciplinary collaboration between Interventional Radiology, Orthopedic /Spine surgeon, Infectious Disease, and Nephrology for safe, effective care in medically complex patients.