CTICasesPigtail Catheter Malpositioned Through the Spleen into a Peripancreatic Abscess
Imaging findings
In a patient with pancreatitis and a multiloculated pleural effusion suspected to be an empyema, a bedside ultrasound-guided pigtail catheter forms normally on the initial post-procedural radiograph but drains poorly over the following days despite intrapleural TPA. A subsequent CT obtained for a falling hematocrit shows the catheter tip has actually traversed the spleen to terminate within a peripancreatic fluid collection near the stomach, rather than lying within the pleural space.
Key takeaways
A pigtail catheter that forms normally despite draining poorly should raise suspicion that it was placed outside the intended space; here the catheter had inadvertently traversed the hypoechoic spleen -- easily mistaken for pleural fluid on bedside ultrasound -- to enter a peripancreatic abscess, and the subsequent TPA administration likely precipitated the drop in hematocrit by causing splenic bleeding.
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