Radiologically guided catheters may be placed de novo or after a large bore thoracostomy tube that is ineffective. The latter occurs when these tubes migrate into the major fissure or are lodged remote from the empyema. The technique for catheter drainage initially involves placement of a diagnostic needle that also serves for localization. If the needle is in the correct position and defines an appropriate route, the catheter is placed in tandem adjacent to the needle. In multiloculated collections or with multiple collections, more than one catheter is indicated.
Drainage is ineffective if the abnormality is tissue rather than fluid.
12 Fr catheters are used routinely. These are single bore, large multi-hole systems. Dislodgment of the catheter is most frequent. Bleeding is rare. Mediastinal Abscess Mediastinal abscesses occur in patients who usually are extremely ill.