Cyst Puncture-Aspiration

Background and indications

Image-guided cyst aspiration involves draining the fluid content of a symptomatic cyst using a fine needle or drain, under ultrasound or CT guidance. Most common locations are renal, hepatic, ovarian, breast, thyroid cysts, and post-operative fluid collections.

Indications include: large symptomatic cyst (pain, compression), infected cyst (abscess), cytological characterization of an atypical cyst, and volume reduction before surgery or treatment.

Pre-procedure assessment

Assessment includes recent imaging (ultrasound, CT, or MRI) confirming the cystic nature, coagulation panel, and infection workup if infection suspected. Approach is planned according to location.

Procedure

Under local anesthesia and ultrasound (or CT) guidance, a fine needle (18-20G) or drain (8-12F) is inserted into the cyst. Fluid is aspirated and sent for cytological, biochemical, and bacteriological analysis. If indicated, a sclerosing agent (ethanol, betadine) may be injected to reduce recurrence risk. The procedure takes 15 to 30 minutes.

Results and scientific evidence

Technical success rate is 95-100%. For symptomatic simple renal and hepatic cysts, recurrence after simple aspiration is 50-80%, reduced to 5-20% with associated sclerotherapy. Aspiration provides immediate relief of compressive symptoms.

Risks and complications

Complications are rare: local pain (5-10%), bleeding (< 2%), infection (< 1%). With sclerotherapy, transient pain is common (30-50%).

Recovery

Return to normal activities same day or next day. Follow-up ultrasound at 1-3 months to detect potential recurrence.

Practical information

The procedure is performed as an outpatient or short inpatient stay depending on the case. It is performed by an interventional radiologist.