AM report PEARLS 1/11: approach to prevertebral fluid collections and mediastinal abscesses!

Approach to prevertebral fluid collections:

  • Aspirate for micro if possible
  • If it’s an abscess, think about the SOURCE:
    1. Hematogenous
    2. Direct spread (oropharyngeal, often anaerobes)
  • Management: medical vs surgical drainage
    1. Medical management if: diskitis, osteomyelitis, phlegmon (inflamed/purulent soft tissue)
    2. Surgical drainage if:
      1. Epidural abscess
      2. Cord compression
  • Spinal instability (higher risk for cord compression)


Approach to mediastinal abscesses:

  • Morbidity and mortality is VERY HIGH!! Previously, 40-50% mortality. Now with IR options, mortality is about 20%
  • Determine ETIOLOGY:
    1. Post-surgical is most common
      1. Post CABG, post valvular surgery, post spinal surgery
    2. Retropharyngeal abscess (more common in kids, immunocompromised patients, elderly)
  • Management:
    1. OR (thoracic surgery) for drainage
    2. IR for drainage
    3. Medical management (opt for this often if drainage is unsafe and patient is stable)


And, a few more PEARLS from Lekshmi on PLEURAL EFFUSIONS:

  • Always look with ultrasound!! They are often hidden on CXR and appear too large on CT/MRI.
  • Always do a diagnostic thora before placing a chest tube, even if suspicion for an empyema is high! You never know what it could be!!




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