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PubMed2002

Image-guided percutaneous drainage of tuberculous iliopsoas and spondylodiskitic abscesses: midterm results.

PURPOSE: To evaluate midterm results of percutaneous drainage (PD) with image guidance in 21 patients with tuberculous iliopsoas abscesses with or without spondylodiskitis. MATERIALS AND METHODS: Computed tomography (CT)-guided PD was performed in 21 patients with 26 tuberculous iliopsoas abscesses. Nineteen patients had bone involvement of two or more vertebrae. Eleven patients with spondylodiskitis had intradiskal abscesses. Five patients had bilateral psoas abscesses. Easily and safely accessible well-circumscribed abscesses larger than 3 cm were selected for PD. Catheters were inserted into the abscess cavities with Seldinger technique in all cases. In conjunction with PD, all patients had antituberculous drug therapy and underwent clinical and imaging follow-up for at least 1 year. RESULTS: Percutaneous catheter placement was successful in all cases without procedural complications. On the basis of CT findings, complete evacuation of all abscesses was achieved initially. During follow-up, six (29%) of 21 patients had recurrences within 1 and 3 months after catheter removal. A total of 37 catheters were used; eight of the 37 catheters were inserted due to recurrences. Four patients needed two PD procedures, and two patients needed three due to recurrences. Four catheters were changed because of obstruction or dislocation. Drainage duration ranged from 5 to 36 days (mean, 14.9 days). The follow-up period was 12-52 months (mean, 24 months). None of the patients, including those with recurrence, required surgical drainage and débridement due to insufficient PD. CONCLUSION: Image-guided PD in conjunction with antituberculous drug therapy is an effective and safe procedure in the treatment of tuberculous iliopsoas abscesses with or without spondylodiskitis.

Abscess↗
PubMed2003

[Pott's disease and different clinical presentations Pott's disease and different clinical presentations].

Skeletal tuberculosis remains a potentially crippling disease in the developing world; particularly as it usually affects children and young adults. The spine is involved approximately 50% of bone and joint tuberculosis cases. The features of four spinal tuberculosis cases were looked over this article. Their ages were between 18 and 76 years. All of them were male and immunocompetent. Pain was the major complaint. There was no life-threatening neurological sign. Among them, a case who was admitted to the hospital with painful torticollis had upper cervical-lower thoracic spinal tuberculosis with psoas abscesses and peritoneal tuberculosis, but no pulmonary involvement. The other cases had thoracolumbal spinal tuberculosis with psoas abscesses and pulmonary tuberculosis of which miliary, chronic and new pulmonary tuberculosis. The whole diagnosis of spinal tuberculosis was made by radiographically-MRI and CT-. Specific antituberculous therapy with supportive care was begun and remarkable responses without surgical intervention were seen on them except miliary pulmonary tuberculosis case. The aim of this presentation was to emphasize the importance of early diagnosis so that adequate pharmacological treatment can be initiated to avoid serious complication.

Adolescent↗
PubMed2006

[Retroperitoneal emphysematous abscess].

The authors report a case of emphysematous psoas abscess. The patient, a 55 year-old man, was insulinorequerant diabetic. He presented with abdominal pain and diabetic ketoacidosis. The diagnosis was made by CT-scan. No portal of entry was found. The evolution was fatal before surgery in spite of probabilistic antibiotherapy.

Diabetes Complications↗
PubMed2003

Is spinal instrumentation a risk factor for late-onset infection in cases of distant infection or surgery? Case report.

As a cause of revision spinal surgery, spinal epidural abscess after instrumentation-assisted fusion is rare in neurosurgical practice. Postoperative infections are frequently seen in the time period soon after surgery. The authors report on the case of a 45-year-old woman who had undergone posterior instrumentation-augmented fusion for L4-5 degenerative spondylolisthesis. Ten months after the operation she presented to the neurosurgery clinic with complaints of severe low-back pain and radicular right lower-extremity pain. She had undergone laparoscopic surgery for acute cholecystitis 1 month prior to readmission. Radiological study revealed a spinal epidural abscess in communication with a right psoas abscess at L4-5. The abscess was drained percutaneously with the aid of C-arm fluoroscopic guidance, and a 6-week course of parenteral antibiotic therapy was administered. Retrograde lymphatic bacterial translocation, hematopoietic spread, and the suitable characteristics in the host may facilitate the development of infection around the implant. Thus, distant surgery and infection may be a risk factor in cases in which spinal instrumentation is placed. In such cases a prolonged antibiotic therapy for distant infection after surgery is recommended.

Antibiotic Prophylaxis↗
PubMed2001

Pneumococcal vertebral osteomyelitis: a unique case with atypical clinical course.

STUDY DESIGN: A case report. OBJECTIVES: To report and discuss a case of pneumococcal vertebral osteomyelitis with meningitis in a previously healthy 51-year-old immunocompetent woman who presented with acute onset lower back pain. SUMMARY OF BACKGROUND DATA: To the authors' knowledge, pneumococcal vertebral osteomyelitis with meningitis in an immunocompetent person with no other predisposing factor has not been reported previously. METHODS: The patient was diagnosed to have pneumococcal meningitis 10 days after the onset of acute and severe lower back pain. Significant improvement of clinical symptoms from meningitis was achieved with appropriate antimicrobial treatment. Lumbar CT and MRI scans were performed on persistence of fever and lower back pain. Loss of height and peridiscal inflammation at L3-L4 and epidural and bilateral psoas abscesses were detected. RESULTS: Diagnosis of pneumococcal vertebral osteomyelitis was established after evaluation of the material obtained from CT-guided aspiration of the psoas abscess and biopsy of the L3 body. With appropriate antimicrobial treatment, the patient's complaints resolved completely. CONCLUSION: To the authors' knowledge, this is the first reported case of pneumococcal vertebral osteomyelitis with meningitis.

Ceftriaxone↗
PubMed2002

Trichinosis of psoas muscle.

There are isolated case reports of Trichinella spiralis infestation in animals from India. We report the first case in man from India. The nematode was discovered incidentally during drainage of psoas abscess.

Diagnosis, Differential↗
PubMed1995

Evaluation of iliopsoas compartment disorders by computed tomography.

BACKGROUND: Iliopsoas compartment lesion frequently goes undiagnosed at clinical presentation. Therefore, even delayed diagnosis may depend on radiographic techniques. Computed tomography (CT) can play an important role in the identification and localization of these lesions. This report concerns the experience of using CT to evaluate the iliopsoas compartment disorder. METHODS: Retrospective review of CT scans for 42 patients who had abnormalities of the iliopsoas compartment revealed that inflammation was responsible in 20, hemorrhage in 8, and tumor in 14 patients. Diagnoses were proven by surgery or biopsy/aspiration in all cases except in five cases whose CT findings correlated with their clinical pictures. A comparison was made among the surgical data, the CT and plain abdominal films. In addition, a comparative evaluation of CT features was also made. RESULTS: By using a hypodense area for the diagnosis of psoas abscess, the sensitivity, specificity and accuracy of CT were 100%, 77%, and 88%, respectively. By using a diffuse involvement of the entire muscle for the diagnosis of hemorrhage, the sensitivity, specificity and accuracy of CT were 63%, 62%, and 62% respectively. By using a bone destruction for the diagnosis of tumors, the sensitivity, specificity and accuracy of CT were 79%, 39%, and 69%, respectively. Evaluation of the iliopsoas compartment lesions was 91% sensitive by CT and 40% sensitive by plain X-ray film. CONCLUSIONS: It is difficult to differentiate iliopsoas abscesses, hematomas and neoplasms without knowing the clinical history. However, when coupled with percutaneous aspiration biopsy, CT has proved to be an effective, rapid means to diagnose and guide the therapy of psoas lesions.

Adult↗
PubMed2002

[Tuberculous spondylodiskitis (Pott's disease): Experience in a general hospital].

BACKGROUND: Pott's disease (PD) is an uncommon extra-pulmonary form of tuberculosis. Dissimilar data about location, diagnosis and treatment from various hospitals and different countries are reported. PATIENTS AND METHOD: We present our experience with Pott's disease at our institution between January 1993 to December 1999, retrospectively, based on clinical bacteriological and pathological research. We found the medical records of 14 patients diagnosed as having PD at our hospital. The following information was obtained: age, sex, symptoms and sings at presentation, PPD tuberculin skin test, imaging techniques, mycobacterium cultures and smear, histopathologic study, treatment and clinical outcome. RESULTS: The number of microbiological diagnosed tuberculosis during the study period was of 1,400 (4 cases per 1,000 admissions). From them, 1,047 cases (74.8%) were pulmonary and 353 cases (25.2%) extra-pulmonary. We found the medical records of 14 patients diagnosed as having PD at our hospital. There was a diagnostic delay between 2 and 720 days. In 5 cases, cultures were positive (1.4% extra-pulmonary). The following information was obtained: age, sex, symptoms and signs at presentation, PPD tuberculin skin test, imaging techniques, mycobacterium cultures and smear, histopathologic study, treatment and clinical outcome. The mean age of the patients was 58 years. Pain and dorsal location were more frequent (8/14). In 6 cases, tuberculosis was diagnosed at other sites. Tuberculin skin test was positive in 7 ases (50%). The diagnosis was confirmed by positive cultures from biopsies in 5 from 8 cases performed and the histology was compatible in 8 from 11 cases performed. Diskitis was presented in 10 cases, soft tissue abscess in 9 cases (psoas abscess in 2); epidural compression in 9 cases and surgery was necessary in 9 cases (diagnostic in 3). CONCLUSIONS: Pott's disease is a rare entity even among HIV-patients in whom extrapulmonar disease has increased. Dorsal location, diskitis and advanced forms of the disease that deserve surgical treatment are frequent.

Aged↗
PubMed1995

Low-velocity gunshot wounds to the spine with an associated transperitoneal injury.

Twenty-nine patients who incurred a transperitoneal low-velocity gunshot wound to their spine were evaluated for the occurrence of spinal infectious complications. All patients underwent an exploratory laparotomy to determine the extent of viscera involvement. No attempt was made to debride the involved spinal area, and the bullet was not removed unless it was easily accessible. Of the 21 patients with a parenchymal and/or noncolonic viscous injury, 17 (77%) were treated with intravenous (i.v.) antibiotics for a minimum of 5 days the remainder received treatment for a maximum of 48 h. All 8 patients with colonic injuries received a minimum of > or = 5 days of antibiotic treatment. Follow-up averaged 44.9 months (range 3-144 months). Only 1 (4.7%) patient with either a noncolonic or parenchymal perforation developed an infectious complication (subdiaphragmatic abscess); two patients (25%) with colonic perforations developed a psoas abscess. No patient developed a spinal infection. This study suggests that patients who sustain a transperitoneal low-velocity gunshot wound to their spine do not need to undergo spinal debridement and may be treated with parenteral antibiotics. Any course of broad-spectrum antibiotics for 5 days appears to minimize infectious complications. Bullet removal and missile tract debridement of the spine is not routinely necessary.

Adolescent↗
PubMed1985

Tuberculosis of the spine. CT demonstration of paravertebral abscess.

Two surgically proven cases of tuberculous psoas abscess are presented. The common findings on CT were low-density paraspinal masses and extension of the lesions which followed the typical distribution of iliopsoas muscle in both cases. The skeletal findings from the spine are also discussed. Our cases indicate the complementary use of plain radiography and CT in the investigation of tuberculous spondylitis.

Abscess↗