Real-time CT fluoroscopy: Usefulness in thoracic drainage

OBJECTIVE. The purpose of our study was to review the application of real-time CT fluoroscopy in the drainage of localized pleural and mediastinal collections. SUBJECTS AND METHODS. Between July 1996 and August 1997, 20 patients with 10 loculated pleural effusions, two mediastinal fluid collections, and 12 focal pneumothoraces were treated using CT fluoroscopy. The patient population was 25-77 years old and included 14 men and six women. Methods of drainage included using a modified Seldinger technique with a guidewire and serial dilators in 10 patients and a single-stick trocar technique in the remaining 14. Total room time, procedure time, and CT fluoroscopy time were recorded. RESULTS. All 24 collections were successfully evacuated using either real-time or interrupted real-time CT fluoroscopy. The real-time capability of CT fluoroscopy proved particularly useful for rapid placement of drainage tubes in patients who were unable to cooperate with breathing instructions and in patients who had a narrow window of access. Average total room time was 65 min. Average procedure time was 32 min, and average CT fluoroscopy time was 143 sec. CONCLUSION. CT fluoroscopy permits rapid drainage of intrathoracic collections. CT fluoroscopy is a particularly useful treatment for patients who are unable to perform breath-holding or in whom access to the drainage site is difficult.