[Paravertebral abscess with secondary meningomyelitis after infiltration therapy. A brief case report].
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Abscess↗
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The iliopsoas abscess: aetiology, therapy, and outcome.
BACKGROUND AND AIMS: The treatment strategy for patients with a retroperitonally localised abscess is controversial as it remains open which fluid collections should be drained by open access or by percutaneously inserted drainage. PATIENTS: Therefore, the data of 40 consecutively treated patients with an iliopsoas abscess were analysed retrospectively. RESULTS: Ten patients suffered from a primary abscess and ten from a post-operative abscess; further, in 20 patients, the aetiology of the abscesses were due to Crohn's disease, neoplasia, spondylitis or other relevant concomitant diseases. Eight of 40 patients were initially treated by image-guided percutaneous drainage (PD), the other by open access drainage. Six patients died (15%), all of them had been operated; 15 (37.5%) patients had a recurrence of their abscess and needed re-operation. Factors predicting a poor outcome were age, APACHE II score, bi-lateral abscesses and a post-operative or bony cause, but the bacteriological findings did not influence the outcome. CONCLUSIONS: We suggest an algorithm for treatment of iliopsoas abscesses depending on number and volume of the abscesses.
APACHE↗
How deep a superficial gravity abscess?
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Adult↗
Pelvic chondrosarcoma in an 18-year-old man masquerading as tuberculous ilipsoas abscess.
Chondrosarcoma is distinctly uncommon in the younger age group. We report an unusual presentation of pelvic bone chondrosarcoma in an 18-year-old man clinically creating an impression of tuberculous abscess, and we discuss the CT and MRI appearances.
Adolescent↗
Endovascular stent-grafting for infected iliac artery pseudoaneurysms.
We report two cases of acutely infected pseudoaneurysms of the iliac arteries, successfully treated with endovascular stent-grafting. Two patients underwent stent-graft treatment for erosive rupture of the iliac artery caused by surrounding infection. The first case is that of a 61-year-old man who had undergone Miles' operation for an advanced rectal cancer. Postoperatively, he developed intrapelvic abscess formation, from which methicillin-resistant Staphylococcus aureus was cultured, followed by rupture of the right external iliac artery. The second case is that of a 60-year-old man who had a pseudoaneurysm of the left common iliac artery, which was contiguous with a left psoas muscle abscess, from which Streptococcus agalactiae was cultured. Both patients were successfully treated with only a stent-graft and antibiotic therapy, and remained symptom-free 12 months and 10 months later. Although endovascular stent-grafting should not be considered standard therapy for infected aneurysms, our cases suggest that it can result in repair of infected aneurysms even in the uncontrolled active stage.
Aneurysm, False↗
Perforated cecal adenocarcinoma presenting as a thigh abscess.
Complicated colorectal carcinoma has several symptoms, the most common being bleeding and obstruction. Occasionally it will cause perforation, which carries a worse prognosis. We report a case of perforated adenocarcinoma of the cecum that presented as an abscess of the thigh. We also present a review of the literature on this subject.
Abscess↗
Primary iliopsoas abscess successfully treated by ultrasonographically guided percutaneous drainage.
We report a case of primary iliopsoas abscess successfully treated by ultrasonographically guided percutaneous drainage. A 56-year-old man presented at our hospital with lumbago, right-sided back pain, fever (temperature 38.5 degrees C) and chills. On physical examination, we found dark red skin, swelling, and tenderness localized at the right side at the back of his waist. Laboratory examination showed leukocytosis (white blood cell count 9700/mm3) with a leftward shift and elevated C-reactive protein (5.2 mg/dl). Ultrasonography (US), computed tomography (CT), and magnetic resonance imaging revealed a hypodense lesion in the right iliopsoas muscle extending to the subcutaneous tissue. About 50 ml of thick yellow pus was obtained by ultrasonographically guided aspiration drainage. A drain catheter was inserted in the abscess cavity. Laboratory findings improved and clinical symptoms abated rapidly after drainage. On the twenty-first day after drainage, US and CT showed that the abscess was no longer present. The patient was discharged after 32 days of hospitalization. As possible primary diseases causing iliopsoas abscess, such as digestive tract disease, tuberculosis, and osteomyelitis, were not found, we diagnosed the disease as primary iliopsoas abscess. Although surgical drainage has been performed in most reported cases of iliopsoas abscess, this case report shows that ultrasonographically guided percutaneous drainage is also effective for treating primary iliopsoas abscess if it is diagnosed early enough.
C-Reactive Protein↗
[Deep venous thrombosis caused by severe infection with group A streptococci].
A 38-year-old diabetic woman presented with a deep venous thrombosis of the right calf muscle two weeks after an infection of the pharynx. After one week of treatment with warfarin, she was readmitted in septic shock with a massive swelling of the leg. The thrombosis had progressed to the right iliac and femoral veins, and an abscess of the iliopsoas muscle caused by group A streptococci was detected. The treatment consisted of surgical drainage, intravenous penicillin and eventually hip joint exarticulation.
Adult↗
Computed tomography-guided percutaneous catheter drainage of primary and secondary iliopsoas abscesses.
AIM: To report our experience with computed tomography (CT)-guided percutaneous catheter drainage (PCD) of iliopsoas abscesses. MATERIALS AND METHODS: Twenty-two iliopsoas abscesses in 21 patients (11 women, 10 men) aged between 18 and 66 years (mean 36 years) were treated with PCD. Abdominal CT demonstrated the iliopsoas abscesses, which were definitively determined by Gram staining and aspirate cultures. Twenty of the 22 iliopsoas abscesses were primary and two were secondary. All PCD procedures were performed under local anaesthesia using a single-step trocar technique (n=19) or Seldinger technique (n=3). RESULTS: PCD was an effective treatment in 21 out of the 22 iliopsoas abscesses. Recurrence was seen in three abscesses as minimal residual collections. Two of them resolved spontaneously with anti-tuberculous regimen. One required percutaneous needle aspiration. The procedure failed in a diabetic patient with a secondary abscess, who died due to sepsis. The length of time that catheters remained in place ranged from 21 to 75 days (mean 59.7 days). Complications included catheter dislocation in four abscesses, which required removal of dislocated catheters and indwelling new ones. CONCLUSION: CT-guided PCD is a safe and effective front-line treatment of iliopsoas abscesses. Surgery should be reserved for failure of PCD and presence of contraindications to PCD.
Adult↗
Pelvic abscess induced by a methicillin-resistant Staphylococcus aureus from haematogenous spread via the CVP line in a burn patient.
A 38-year-old female patients was found accidentally to have a positive culture of MRSA from a routine CVP catheter tip culture 1 week after she had complete wound closure. She was recovering from a partial skin thickness burn covering 42 per cent TBSA on the trunk and extremities. Fever and hip pain developed abruptly 1 week later when she was ready for discharge from hospital. Magnetic resonance imaging (MRI) of the pelvis disclosed an intramuscular abscess. Open drainage was performed and pus culture yielded a MRSA with the same sensitivity profile as the previous CVP tip culture. Vancomycin 500 mg every 6 h was used for 3 weeks until the drain culture disclosed a negative result, and a follow-up MRI indicated a loss of the abscess space. Follow-up at an outpatient clinic 3 months later showed that the patient remained symptom free. In this patient haematogenous dissemination was the most likely route of pelvic abscess formation. It should be remembered that MRSA infection is not always only a local problem, especially in the immunocompromised condition of burn injury.
Adult↗
[Imaging findings in 122 cases of Pott's disease].
Spinal tuberculosis is a frequent skeletal involvement in tuberculosis. We report 122 cases between 1983 and 1998 of Pott's disease explored by plain radiographies in all cases, CT-scan in 22 cases and MRI in 6 cases. The lesion involved one localization in 98 cases, two localizations in 9 cases and multiple localizations in 15 cases. The usual form associating the discal and vertebral involvement was noted in 70%. Unusual forms were seen in 30% of the cases The localizations were: posterior arch (20 cases), centrosomatic (10 cases), suboccipital (4 cases) and subligamentar (2 cases). In addition, the CT scan noted vertebral lesion with soft tissue abscess in all cases and epidural lesion in 9 cases. MRI performed in 6 cases showed epidural lesions in 4 cases: epiduritis (2 cases) and abscess (2 cases). The disco-vertebral puncture-biopsy, performed in 12 cases, confirmed the diagnosis in 7 cases. The diagnosis of Pott's disease was confirmed biologically in 30 cases. Radiographic exploration of Pott's disease is improved by the contributions of CT and MRI which can identify sequestra, perilesional sclerosis and epidural or soft tissue abscesses. Discovertebral aspiration biopsy provides the key to diagnosis.
Adolescent↗
Late presentation of infection as a complication of Dwyer anterior spinal instrumentation.
Delayed presentation of infection is a rare complication of anterior instrumentation and fusion for scoliosis. Three cases that followed the Dwyer procedure are reported. Pain was absent in these patients, but mild constitutional symptoms were present. An elevated erythrocyte sedimentation rate (ESR) is an important indicator of this complication. Two patients developed groin abscesses and sinuses as the hallmark of deep infection. Infection resolved after removal of instrumentation and local debridement.
Adolescent↗
Primary vs secondary iliopsoas abscess. Presentation, microbiology, and treatment.
OBJECTIVE: To review the characteristics of patient presentation, microbiology, and treatment of primary iliopsoas abscess. DESIGN: A case series of patients with iliopsoas abscess diagnosed on computed tomographic scans from 1987 to 1994. SETTING: Tertiary care inner-city university hospital. PATIENTS: Eleven patients with secondary iliopsoas abscess, defined as being secondary to gastrointestinal or genitourinary causes or trauma, and seven patients with primary abscess, defined as the absence of the above causes. MAIN OUTCOME MEASURES: Patient characteristics, presenting symptoms and signs, microbiologic characteristics, treatment, and clinical course of patients with primary iliopsoas abscesses compared with those in patients with secondary abscesses. RESULTS: In the primary group, six patients (86%) were intravenous drug users and four (57%) were positive for human immunodeficiency virus. Staphylococcus aureus grew from cultures from five of seven patients with primary abscesses, whereas secondary abscesses had enteric flora. The typical patient presentation included fever, with complaints of pain in the flank, hip, or abdomen. Comparison of abscess drainage options showed shorter hospitalizations for surgical drainage than for percutaneous drainage (15.9 vs 28.5 days; P < or = .01). CONCLUSIONS: A patient who presents with pain in the flank, hip, or abdomen may have a primary iliopsoas abscess. Computed tomography is the standard method of diagnosis. Antibiotic regimens for patients with primary iliopsoas abscess should include coverage for S aureus, and patients with secondary abscesses should have antibiotic regimens tailored for enteric bacteria. Drainage of abscess is essential for appropriate treatment, and surgical drainage is superior to percutaneous drainage in achieving prompt recovery.
AIDS-Related Opportunistic Infections↗
Percutaneous drainage of tuberculous iliopsoas abscesses under image guidance.
Most intra-abdominal and other types of fluid collections are now successfully drained percutaneously under image guidance. The utility of percutaneous drainage of tuberculous abscesses, especially those associated with osseous changes, is, however, less well established. Six patients with tuberculous iliopsoas abscesses were successfully managed by percutaneous drainage combined with antituberculous therapy. The abscesses were bilateral in one patient and unilateral in the other five. Drainage was by needle aspiration under ultrasound (US) guidance in one patient, and by catheter under CT guidance in the other patients. Three patients had associated osseous changes. There were no procedural complications. Tuberculous iliopsoas abscess can be successfully treated by percutaneous drainage and appropriate antituberculous therapy.
Adolescent↗
Iliopsoas abscess: etiology, diagnosis, and treatment.
Iliopsoas abscess is a rarely encountered entity. Early diagnosis is hindered by a nonspecific clinical presentation. The resulting delays in therapy increase morbidity and mortality rates. Our recent experience with three cases of iliopsoas abscess is presented. Based on a review of the literature, diagnostic and treatment recommendations are made.
Adult↗
[Multimodal imaging exemplified by gluteal abscesses--a case report].
The detection of occult abscesses can draw a long chain of diagnostic procedures as the procedures as the presented case documents. Next to conventional X-ray studies and examination by ultrasound scintigraphy is available. Studies of the skeleton by the latter using phosphonates for osteomyelitis or 111-I-labeled neutrophils or 99m-Tc-labeled monoclonal antibodies against neutrophilic surface-antigens for the detection of abscesses in soft tissues are of recent interest. MR-imaging is used for preoperative planning after successful detection.
Aged↗
[Pyogenic sacroiliitis complicated by iliopsoas muscle abscess].
Both pyogenic sacroiliitis and iliopsoas muscle abscess are uncommon infectious entities, and their coexinstence has been reported in very few patients. We present here the case of a woman who developed a large iliopsoas abscess as a consequence of a pyogenic sacroiliitis, initially misdiagnosed as a common sciatica and treated with corticosteroids. The patient was cured by the surgical drainage of the abscess and a long-lasting antibiotic treatment. We discuss diagnostic difficulties linked to the two infectious entities, their possible pathogenic connections, the role of imaging procedures, and therapeutic options. We conclude that pyogenic sacroiliitis and the potential evolution to an iliopsoas abscess must be taken into consideration in the differential diagnosis of lower back pain, especially if fever is a concomitant sign.
Aged↗
Post-traumatic retroperitoneal colonic injury presenting as gluteal abscess.
We report an 8-year-old boy who sustained blunt retroperitoneal right colonic injury in a vehicular accident and presented with gluteal abscess. Surgical exploration revealed perforated posterior wall of ascending colon with surrounding retroperitoneal abscess communicating with the gluteal region. Right hemicolectomy with drainage of retroperitoneal and gluteal collections resulted in satisfactory recovery.
Abdominal Injuries↗