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PubMed1994

[Ultrasonography in the diagnosis and treatment of psoas abscess. Apropos of a study with 30 patients].

The abscess of psoas are more often secondary to a loco-regional cause. The authors report a series of 42 abscess of psoas in 30 patients during 3 years. It concerns 16 men and 14 women witch a mean age of 35 years. The abscess was secondary to a spondylodiscis in 25 patients and primary in 5 patients. The size of the abscess was upper 5 cm with a variable ultrasound structure: liquid in 33 cases, hypoechogenic in 9 cases. All patients underwent a percutaneous treatment guided by ultrasonography. A single or multiple evacuation puncture with 16 Gauge needle were performed for 40 abscess. Complementary percutaneous drainage with 14 french drain was used in 3 cases. In 2 other cases, the percutaneous drainage was used firstly. The bacteriological study of puncture liquid isolated the germ in 8 cases. Evaluation has been assessed in only 29 cases. The recovery was reached in 12 abscess on 15 which were treated by a single puncture. In 10 abscess on 13 treated by multiple puncture; and in 4 abscess an 5 managed by drainage. The results demonstrate the accuracy of single or multiple drainage puncture associated with adapted antibiotherapy in the management of abscess.

Adult↗
PubMed1991

[A case of psoas abscess due to renal pelvic carcinoma complicated with non-ketotic hyperosmolar diabetic coma].

A 85-year-old man was admitted to our hospital because of semicomatous status. Laboratory data on admission showed elevation of blood sugar (823 mg/dl) and serum osmotic pressure (345 mOsm/l), but ketonuria was not detected. Non-ketotic hyperosmolar diabetic coma was diagnosed. The insulin infusion and physiological saline improved the blood sugar level and consciousness within a day. The abdominal ultrasound examination revealed an abscess in the left kidney and right psoas muscle. The same findings were seen by abdominal computed tomography but the possibility of malignant neoplasm of the left kidney could not be ruled out because of a swelling of the left adrenal gland. Pain associated with psoas abscess and low grade fever were observed. Because of his poor general condition, drainage of the abscess was not performed and conservative therapy using antibiotics was administered. Without any improvement of the abscess, he died due to general deterioration four months later. Autopsy findings showed carcinoma of the left renal pelvis and metastasis to the right psoas muscle, left adrenal gland, liver, bilateral lungs and lymph modes. Psoas abscess is a relatively uncommon disease, especially in elderly patients. The etiology of the disease is divided into primary and secondary causes. Most secondary psoas abscess cases are caused by intestinal diseases, and Crohn's disease has been related to the highest incidence. A few cases of psoas abscess caused by colorectal carcinoma have been reported. Ultrasound and computed tomography are useful in diagnosing this disease and drainage of an abscess is necessary for therapy and proving the cause. Cancer metastasis should considered in differential diagnoses, when psoas abscess is seen in elderly patients.

Aged↗
PubMed2002

Primary psoas abscess complicating a normal vaginal delivery.

BACKGROUND: Psoas abscess is a rare and potentially dangerous complication of normal delivery. CASE: We describe a case of primary psoas abscess after normal vaginal delivery. A young woman presented with fever, left back pain, left lower abdominal pain, and hip pain starting on postpartum day 2. Computed tomography demonstrated a large retroperitoneal collection. Aspiration drainage of the abscess under computed tomography guidance isolated Streptococcus viridans, which responded to antibiotic therapy and percutaneous drainage with complete resolution. CONCLUSION: A high index of suspicion is necessary for diagnosis of psoas abscess, which should be considered in postpartum patients with pyrexia, back and hip pain, and a normal neurologic examination. Computed tomography is effective for diagnosis and allows percutaneous drainage of the abscess.

Abdominal Pain↗
PubMed1989

Adenocarcinoma of unknown primary site (ACUPS) presenting as a psoas abscess.

The presentation of a psoas abscess is commonly seen in conjunction with infection, especially tuberculous. Involvement of the psoas muscles with tumour, however, is extremely rare. We present a case in which adenocarcinoma of unknown primary site infiltrated the psoas muscle, thus mimicking a psoas abscess. A review of this unusual tumour type is discussed.

Abscess↗
PubMed2006

A rare cause of flank mass: psoas abscess due to extensive primary thoracolumbar tuberculous spondylodiskitis.

Psoas abscess secondary to tuberculous spondylodiskitis is usually a complication of thoracolumbar vertebrae disease. The psoas abscess may be difficult clinically to diagnose because of its rarity, insidious onset of the disease, and nonspecific clinical presentation. We report multidetector CT and MR imaging findings of a psoas abscess secondary to primary tuberculous spondylodiskitis of the spine from the T3 to L2 vertebrae, which presented as a flank mass.

Adult↗
PubMed2002

[Psoas abscess. Etiology and treatment].

Psoas abscess is in general a syndrome with low incidence. In the following, two cases are presented which describe the etiology, diagnosis, and treatment of primary and secondary retroperitoneal manifestations. The article mainly focuses on the different respective surgical procedures. Because of its rareness, an overview of further cases discussed in the literature is provided.

Aged↗
PubMed2002

Primary psoas abscess. Report of three cases.

BACKGROUND: Primary psoas abscesses are a rare clinical entity with subtle and non specific symptoms, most commonly seen in patients predisposed to infections. Early diagnosis and appropriate management are therefore challenging aspects for physicians. PATIENTS AND METHODS: We present three patients with primary pyogenic psoas abscess, treated at the Heraklion University Hospital, during a 5-year period. The two male and one female patient, aged 36-51 years were admitted with fever, abdominal pain and a palpable tender mass. RESULTS: The classical sign of limping was absent in all cases. Positive psoas symptoms were detected in only two patients. CT scan accurately confirmed the diagnosis in all cases. The patients were successfully treated with antibiotics and prolonged surgical drainage. Staphylococcus aureus was the causative microorganism in the first two and Bacteroides fragilis in the third patient. This is the first reported case resulting from this specific bacteria. None of our patients had any predisposing risk factor. CONCLUSIONS: A high index of suspicion is mandatory to enable early recognition of this rare clinical disease. CT scan is the standard diagnostic tool to confirm diagnosis. Prolonged drainage and appropriate antibiotics are essential for the successful treatment of primary psoas abscesses.

Adult↗
PubMed1987

CT-guided percutaneous drainage of psoas abscess.

Two cases of pyogenic psoas abscess were diagnosed and treated by CT-guided percutaneous catheter drainage. In these 2 patients there was rapid clinical improvement and tomographic disappearance of the masses. Image-guided percutaneous drainage of psoas abscess appears to be a safe and effective alternate to open surgical drainage.

Abscess↗
PubMed1985

Psoas abscess in inflammatory bowel disease.

The inflammatory bowel disease (IBD) is sometimes complicated by the development of a psoas abscess. We recently encountered three patients of IBD with psoas abscess. Two patients had Crohn's ileocolitis and one with ulcerative colitis. During 1979-1984, 23 patients with psoas abscess due to a variety of underlying disease processes were seen at our institution. At the same time period, 483 cases of Crohn's disease and 283 cases of ulcerative colitis were encountered. Therefore, of 766 patients with IBD only three were complicated by psoas abscess (incidence ratio = 0.6%). Thus, psoas abscess was a very rare complication of IBD in patients seen at our institution. In our series of 23 psoas abscess patients, IBD was not a major causative factor. Additionally, to our knowledge, psoas abscess complicating ulcerative colitis has not been reported previously.

Abscess↗
PubMed1997

Ilio-psoas abscess in the neonate.

Ilio-psoas abscess is rare in children and exceptional in the neonate. This report describes a case of idiopathic ilio-psoas abscess in a neonate with no etiologic factor known. The diagnosis was made by ultrasonography and computed axial tomography. The treatment was extraperitoneal surgical drainage and systemic antibiotics.

Diagnosis, Differential↗
PubMed1999

Psoas abscess: a 10 year review.

Psoas muscle abscesses are rarely encountered yet, and pose diagnostic and therapeutic challenges because of nonspecific clinical presentations. We retrospectively reviewed the medical records of adults with a psoas muscle abscess who were admitted to our hospital from January, 1988 to May, 1998. Over this ten year period, psoas abscesses were found in 11 cases. Six cases were primary and Staphylococcus spp. was the most commonly isolated. Five cases were a secondary psoas abscess while urological problems were the most common underlying condition. Fever, chills, lower back or flank pain and a palpable mass were the most common manifestations. Only one patient presented the classic triad of fever, flank pain, and limitation of hip movement (a typical psoas sign). Leukocytosis was the most common laboratory finding. Two of 11 cases presented septic shock. Two patients were admitted to the hospital with the initial diagnosis of psoas abscesses. Computerized tomographic (CT) scans accurately confirmed the clinical diagnosis in 9 of 11 patients. Diagnosis was then established one each by ultrasound (US) and magnetic resonance imaging (MRI), respectively. Four of 11 patients had negative findings initially by US. All patients were managed with drainage and antibiotics, nine were drained surgically, and two were managed with percutaneous drainage under CT guidance. Two patients died. Because of the lack of the classic symptoms and signs in most cases, a high degree of suspicion is important for early diagnosis of psoas abscess. CT scan is the standard technique of diagnosis. The prognosis is generally good with appropriate antibiotic treatment and complete drainage.

Adult↗
PubMed2001

Unusual presentation of psoas abscess in a child.

Primary abscess of the psoas muscle is relatively rare in infants and young children. The clinical presentation of the disease, with limping, fever, and abdominal pain, may be confused with conditions such as septic arthritis of the hip, osteomyelitis, or appendicitis. The authors present an unusual case of a ruptured left psoas abscess presenting as generalized peritonitis in a child. J Pediatr Surg 36:1859-1860.

Diagnosis, Differential↗
PubMedDate not supplied

Psoas abscess with sepsis mimicking traumatic hemorrhagic shock after a fall.

Abscess of the psoas muscle is infrequently encountered. An infectious emergency of this type usually presents in a nonspecific manner and thus poses a significant diagnostic challenge to the emergency physician. Diagnosis and specific treatment are often delayed, which can lead to increased mortality. This case report presents a patient with altered mental status and hypotension after a fall, who was initially managed as a trauma victim. Emergency department evaluation initially focused on a traumatic etiology of the above abnormalities. Subsequent assessment determined that the patient's condition was due to an underlying psoas abscess with sepsis. Appropriate anatomy, clinical presentation, and management are discussed in hopes of increasing physician awareness of this uncommon infectious condition.

Accidental Falls↗
PubMed1995

[Psoas abscess mimicking septic arthritis of the hip].

Primary psoas abscess is a relatively rare and imposes diagnostic and therapeutic challenges. We describe a 16-year-old boy who presented with fever, limp and the clinical picture of septic arthritis of the hip joint. He did not respond to conventional medical treatment. When the diagnosis of psoas abscess was made and the abscess was drained, he gradually recovered. The diagnosis of psoas abscess is frequently missed. Correct diagnosis is very important because usually, cure only follows surgical drainage.

Adolescent↗
PubMed2001

Psoas abscess: a primer for the internist.

Psoas abscess is a rare condition with vague clinical presentation. In this article, its epidemiology, etiology, bacteriology, diagnosis, and treatment are discussed. Common diseases that may be erroneously diagnosed in patients with psoas abscess are presented.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

[Bilateral brucellosic psoas abscess: one case is related and literature review].

The Brucellosis is a zoonotic and unfrequent infection but it is endemic in Spain. It is a well documented cause of fever of unknown origin with varied and nonspecific symptoms. The onset of symptoms of brucellosis may be abrupt or insidious, developing over several days to weeks. Virtually any organ system can be involved with brucellosis and localization of the process may cause focal symptoms. The most frequent focal presentation is the osteoarthicular. Some times it can complicates with para-perivertebral abscess. The unilateral psoas abscess(PA) is uncommon and the bilateral afection is exceptional. The manifestations of PA usually are insidious, the classic tiad of: feber, lumbar pain and functional impotence is rare. For the diagnosis the serology c tests and cultures are necesary. The imaging techniques like: Ultrasonography and Tomography have improved the diagnosis and treatment of this pathologies' complications. The recommended therapy is the use of doxycicline and streptomicine. Some times the use of percutaneous drainage or open surgery is necessary.

Adult↗
PubMedDate not supplied

Psoas abscess secondary to tuberculous lymphadenopathy: case report.

Tuberculous psoas abscesses, a well-known sequel of tuberculous spondylitis, very rarely develop without concomitant spinal involvement. We report a unique case where a psoas abscess was secondary to retroperitoneal tuberculous lymphadenopathy in a 13-year-old boy who had no demonstrable findings of spinal tuberculosis. Computed tomography showed an obvious communication between the necrotic and calcified retroperitoneal lymph node and the psoas abscess. To the best of our knowledge, fistulization of tuberculous lymph nodes into the psoas sheath has not been reported in the English-language literature.

Adolescent↗
PubMed1993

[Psoas abscesses--still a current problem in Denmark].

Two cases of secondary, non-tuberculous psoas abscesses are presented, stressing that psoas abscesses are not restricted to tuberculous diseases of the spine (Pott's disease). In one case, the aetiology was diverticulitis with perforation located to the left colonic flexure. The patient was treated by a two-step operative procedure creating drainage and a primary anastomosis, which in the post-operative course was leaking. The patient died because of recurrent abscess formation and sepsis. The other patient received an aorto-bifemoral prosthesis two years prior to the current hospitalisation, and a bilateral psoas abscess appeared in the presence of this prosthesis. In both cases, the psoas abscesses presented below the inguinal ligament before diagnosis was made and even in the latter case with a delay of several months.

Aged↗