he patient's condition suggests the possibility of infected pseudocyst/abscess formation, dia gnostic aspiration under sonograph ic guidance using a 22 gauge need le is a propr iate and readily accomplished Such an infected collection left undrained carries a mortality rate in excess of 50 %(10)(Figure 10) Figure 10a ps Transverse scan demonstrating a large pseudocyst(ps) containing scattered debris throughout. Both walls of the stomach(arrows)are well visualized immediately anterior to the pseudocyst indicating its location in the lesser sac. a aorta Figure 10b. A somewhat oblique view through the same pseudocyst: a 22 gauge needle(arrow)is in place to determine the presence or absence of superimposed infection Sonographic documentation of the presence of a peripancreatic fluid collection, presumably a pseudocy st for several weeks should serve as the indicator for surgical or percutaneous intervention. Five to six weeks is cons idered appropr iate because by that time the walls of the pseudocyst are relatively well-formed and the chances for spontaneous regression have diminis hed. Then, too, the poss ibility of superimposed complications such as bleeding infection, and spontaneous rupture begins to rise subs tantia lly Formation of pseudoaneurysms of vessels about the pancreas which may accompany pse udocyst formation can be detected with either color or spectral Doppler interrogation(11) Percutaneous intervention A multip lic ity of techniques and guidance modalities have been described in the approach to percuta neo us drainage of pancreatic pseudocysts and abscesses. CT is a frequently employed and effective method for placement of drainage tubes. The combined use of real-time ultrasound and fluoroscopy offers several attractive features. Ultrasound is cons iderably less costly and generally more wide ly and readily availa ble Then, too, ultrasound perm its continuous monitoring of the puncturing need le(or trochar-catheter dev ice) to insure its proper placement w ithin the fluid collection. The supplemental use of fluoroscopy to follow guide w ires and catheters dur ing the introduction process serves to min imize chances for kinking of wires or tubes. We have found the combined use of sonographic and f luoroscopic mon itor ing of fluid drainage to provide the most cost effective, rapid, and read ily available approach(8, 12-18). a multiplicity of techniques and guidance modalities have been described in the approach to per cutanea us drainage of pancreatic pse udocysts and abscesses. CT is a frequently employed and effective method for placement of drainage tubes. The combined use of real-time ultrasound and fluoroscopy offers several attractive features. Ultrasound is cons iderably less costly and generally more widely and readily available. Then, too,the patient's condition suggests the possibility of infected pseudocyst /abscess formation, diagnostic aspiration under sonographic guidance using a 22 gauge needle is appropriate and readily accomplished. Such an infected collection lef t undrained carries a mortality rate in excess of 50 % (10) (Figure 10) . Figure - 10a. Transverse scan demonstrating a large pseudocyst (ps) containing scattered debris throughout. Both walls of the stomach (arrows) are well visualized immediately anterior to the pseudocyst indicating its location in the lesser sac. a = aorta. Figure - 10b. A somewhat oblique view through the same pseudocyst; a 22 gauge needle (arrow) is in place to determine the presence or absence of superimposed infection. Sonographic documentation of the presence of a peripancreatic fluid collection, presumably a pseudocyst, for several weeks should serve as the indicator for surgical or percutaneous intervention. Five to six weeks is considered appropriate because by that time the walls of the pseudocyst are relatively well-formed and the chances for spontaneous regression have diminished. Then, too, the possibility of superimposed complications such as bleeding, infection, and spontaneous rupture begins to rise substantia lly. Formation of pseudoaneurysms of vessels about the pancreas which may accompany pseudocyst formation can be detected with either color or spectral Doppler interrogation (11) . Percutaneous intervention A multiplicity of techniques and guidance modalities have been described in the approach to percutaneous drainage of pancreatic pseudocysts and abscesses. CT is a frequently employed and effective method for placement of drainage tubes. The combined use of real-time ultrasound and fluoroscopy offers several attractive features. Ultrasound is considerably less costly and generally more widely and readily available. Then, too, ultrasound permits continuous monitoring of the puncturing needle (or trochar -catheter device) to insure its proper placement within the fluid collection. The supplemental use of fluoroscopy to follow guide wires and catheters during the introduction process serves to minimize chances for kinking of wires or tubes. We have found the combined use of sonographic and fluoroscopic monitoring of fluid drainage to provide the most cost ef fective, rapid, and readily available approach (8, 12-18). A multiplicity of techniques and guidance modalities have been described in the approach to per cutaneous drainage of pancreatic pseudocysts and abscesses. CT is a f requently employed and effective method for placement of drainage tubes. The combined use of real-time ultrasound and fluoroscopy offers several attractive features. Ultrasound is considerably less costly and generally more widely and readily available. Then, too