Percutaneous sclerotherapy of cystic lesions

Abstract

With modern cross-sectional imaging techniques, cystic lesions are very common and usually incidental findings, especially if small. However, when cysts enlarge, become infected, bleed, or undergo torsion, they can be symptomatic, and percutaneous drainage can be effective in the management. When cysts recur after aspiration, which is often the case for hepatic and renal cysts, cyst sclerosis or surgical unroofing may be required. This article describes the indications for and technical aspects of percutaneous sclerotherapy of cystic lesions of multiple organ systems.

Keywords: alcohol; cysts; interventional radiology; sclerotherapy.

Figure 1

A 43-year-old woman with left upper abdominal pain. (A, B) Axial-reformatted and coronal-reformatted images from a contrast-enhanced computed tomography scan shows large thin-walled splenic cyst. (C)The cyst was aspirated with a 5F pigtail catheter, and a spot fluoroscopic image of the catheter after injection of diluted contrast demonstrates the contrast is entirely contained within the cyst, making it suitable for sclerosis.

Figure 2

A 40-year-old woman with nausea, vomiting, and abdominal pain. (A) Axial-reformatted image from a contrast-enhanced computed tomography (CT) scan shows a large thin-walled cystic lesion in the pelvis (arrow), which was confirmed to be a peritoneal inclusion cyst. The dilated tubular structures in the pelvis are consistent with hydrosalpinx (arrowheads). (B) A spot fluoroscopic image after injection of diluted contrast shows the contrast is entirely contained within the cyst, making it suitable for sclerosis. The cyst was subsequently sclerosed with ethanol. (C) Contrast injection following ethanol sclerosis was performed, showing the cyst had decreased in size since the first treatment. (D) A final third ethanol sclerosis was performed, followed by a contrast injection demonstrating further decrease in the size of the cyst. (E) Axial-reformatted image from a contrast-enhanced CT scan after three ethanol sclerosis treatments shows a significant decrease in size of the peritoneal inclusion cyst (arrow). Hydrosalpinx persists (arrowheads).

Figure 3

A 58-year-old man with a history of cutaneous apocrine adenocarcinoma of the left axilla status axillary lymph node dissection. (A) Axial-reformatted image from a contrast-enhanced computed tomography scan shows a loculated fluid collection in the left axilla consistent with a lymphocele (arrow). (B) Spot fluoroscopic image after contrast injection shows a 6.3F catheter in the lymphocele. The contrast is entirely contained within the lymphocele, making it suitable for sclerosis.