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Results for “Psoas Abscess”

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PubMed1994

[Chronic spondylogenic pain syndrome--tb-spondylitis?].

The incidence of tuberculosis is increasing in many of the industrialized countries, mainly due to the spreading of HIV infections, the migration from countries with high prevalence of tuberculosis and possibly through the increase of the aged population. In 10 to 25% of the cases, tuberculosis manifests itself in extrapulmonary organs. One of the most frequent locations is the spine. The symptoms of the TB spondylitis are unspecific, and the course is creeping, which makes an early diagnosis difficult. Because of the frequent, severe complications, this must be attempted. In patients belonging to a risk group or with known exposition to tuberculosis and vertebral pain, the TB spondylitis must be included in the differential diagnosis. Combined chemotherapy is the key to successful therapy and can make surgical interventions or immobilization unnecessary. Two cases are presented, and the disease of the TB spondylitis is discussed.

Adult↗
PubMed1993

Osteomyelitis of the spine due to Salmonella: case report, review of clinical aspects, pathogenesis and treatment.

Osteomyelitis of the spine caused by Salmonella is rare. The authors describe a case in which the patient had fusion of the L1 and L2 vertebrae, which were affected by osteomyelitis. The infecting organism was Salmonella typhimurium. The authors describe the relationship of the vascular anatomy to the development of osteomyelitis of the spine. They discuss the clinical features, diagnosis, pathogenesis and treatment of the disease. Although the association of osteomyelitis due to Salmonella and sickle cell disease has long been known, this patient did not have sickle cell disease or any other condition that would compromise the immune system.

Anemia, Sickle Cell↗
PubMed1995

[Extrapulmonary mycobacterial infection with multiple cold abscesses].

We report one case of extrapulmonary mycobacterial infection, in the absence of HIV infection, singular by a clinical presentation simulating a tumor, associating a bulky intrahepatic mass, an abscess of the psoas, multiple intracerebral lesions, and an obstructive intracardiac mass of the right ventricle, which required a surgical resection. We comment the type of the mycobacterium involved and the hepatic and cardiac localisations, since macronodular hepatic abscesses are rare, and cardiac abcesses, exceptional.

Adult↗
PubMedDate not supplied

Iliopsoas abscess: a report of 24 patients diagnosed by CT.

BACKGROUND: We wanted to define the role of computed tomography (CT) in the diagnosis, etiology, and treatment of iliopsoas abscess. METHODS: Twenty-four patients (18 men, six women; age range = 17-86 years) with iliopsoas abscesses diagnosed over 8 years were retrospectively reviewed. All presented with fever and elevated white blood cell counts. Twenty-one had abdominal, flank or pelvic pain and nine had specific psoas signs suggesting the diagnosis. RESULTS: Seventeen of the abscesses were right-sided. Twenty were regarded as secondary to various underlying causes that were clearly demonstrated on CT and related to gastrointestinal (n = 12), skeletal (n = 5), or urinary tract (n = 3) diseases. All patients received appropriate antibiotic treatment. Thirteen also had their abscesses drained and eight had definitive surgical procedures. CONCLUSION: CT is an effective imaging technique for diagnosing iliopsoas abscess, even when classic clinical signs are absent. Treatment by percutaneous drainage under CT guidance is another advantage. When a psoas abscess is a complication of Crohn's disease, resection of the affected bowel segment is recommended in addition to drainage because drainage alone even in conjunction with appropriate medical therapy is usually not effective.

Adult↗
PubMed2006

Association between rmpA and magA genes and clinical syndromes caused by Klebsiella pneumoniae in Taiwan.

BACKGROUND: The association of the magA gene with the hypermucoviscosity phenotype relevant to the pathogenesis of Klebsiella pneumoniae liver abscess has been reported in Taiwan. Similarly, the rmpA gene, known as a positive regulator of extracapsular polysaccharide synthesis that confers a mucoid phenotype, may be another candidate gene causing hypermucoviscosity. However, the association of rmpA with K. pneumoniae clinical syndromes is unreported. We aimed to investigate the clinical correlation between rmpA and primary Klebsiella abscess, focusing on sites other than the liver. METHODS: From July 2003 through December 2004, a total of 151 K. pneumoniae isolates recovered from 151 patients with bacteremia were collected from 2 large medical centers in southern Taiwan. Clinical data were collected from medical records. The genes rmpA and magA were amplified by polymerase chain reaction using specific primers. RESULTS: The prevalences of hypermucoviscosity, rmpA, and magA were 38%, 48%, and 17%, respectively. As determined by statistical multivariate analysis, strains carrying rmpA were significantly associated with the hypermucoviscosity phenotype, and there was a significant correlation with purulent tissue infections, such as liver abscess and lung, neck, psoas muscle, or other focal abscess. CONCLUSION: Our data support a statistical correlation between the rmpA gene and virulence in terms of abscess formation for these hypermucoviscous K. pneumoniae strains. Hypermucoviscosity associated with rmpA, together with a thorough physical examination, may be helpful as a guide to carry out appropriate diagnostic tests on patients with an initially unknown source of K. pneumoniae bacteremia, particularly when looking for the occurrence of an underlying abscess.

Bacteremia↗
PubMed2004

Percutaneous drainage of large tuberculous iliopsoas abscess via a subinguinal approach: a report of two cases.

Two patients who had large tuberculous abscesses that were successfully treated with percutaneous drainage alone are reported. A new approach, called the "subinguinal approach," was used. This new technique avoids the bowel loops and pelvic organs (which can be limitations when using the anterior abdominal approach) by inserting the catheter through the subinguinal portion of the psoas muscle into the abscess. Compared to the posterior approach, this technique is more comfortable for the patient (who prefers a supine position) and is not limited by the iliac bone. The technique, clinical course, and outcome are described.

Adult↗
PubMed2005

Abdominal wall and thigh abscess resulting from the penetration of ascending colon cancer.

An unusual case is described in which an abdominal wall and thigh abscess was an initial symptom of ascending colon cancer. A 76-year-old woman was referred to our hospital for investigation of fever and abdominal and thigh swelling. Computed tomography revealed a right abdominal wall, retroperitoneal, psoas and thigh abscess formation suspected to be caused by colon perforation. Due to the patient's poor general condition, local drainage of the abscess was performed on the following day of hospitalization. Histological examination of necrotic tissues removed form the retroperitoneal cavity demonstrated adenocarcinoma of the colon. The patient subsequently underwent right hemicolectomy with lymph nodal dissection after 19 days of the drainage procedure and was transferred to another hospital on the 49th day following the second surgery.

Abdominal Wall↗
PubMed2006

Hyperimmunoglobulin E syndrome (job syndrome) discovered in a patient following corrective spine surgery: case report and review of the literature.

STUDY DESIGN: A case report of the hyperimmunoglobulin E syndrome (Job syndrome) presenting in the context of late postoperative infection after corrective surgery for scoliosis. OBJECTIVE: To describe the clinical presentation and treatment of a patient with Job syndrome, and its implications for spine surgeons. SUMMARY OF BACKGROUND DATA: Job syndrome classically presents with a triad of increased serum immunoglobulin E, multiple abscesses, and pneumonia with pneumatocele formation. In recent years nonimmunologic manifestations have been described, including scoliosis, joint hypermobility, eosinophilia, and atopy. METHODS: A 15-year-old female presented with local swelling and fever 2 years after anterior lumbar discectomy and fusion with spinal instrumentation involving T11-L3 levels. Computerized tomography revealed paravertebral, psoas, and pulmonary abscesses. The implants were removed and antibiotic therapy instituted. Further investigation revealed features of the hyperimmunoglobulin E syndrome (Job syndrome). RESULTS: The patient's symptoms resolved, as did markers of inflammation. CONCLUSIONS: Job syndrome is a primary immunodeficiency often associated with scoliosis. Given the implications for surgical outcome in immunodeficient patients, the diagnosis should be considered and, blood tests instituted in patients with scoliosis with any of the associated history and physical findings of Job syndrome.

Adolescent↗
PubMed1997

[Coxitis fugax. The role of diagnostic imaging].

Between 1990 and 1996, 129 children (mean age 4.8 years) with hip pain were examined consecutively. In group I (n = 100, mean age 4.14 +/- 2.2), transient synovitis of the hip was diagnosed; group II (n = 29, mean age 7.3 +/- 2.1) showed the following diagnoses: Perthes' disease (n = 12), early slipped capital femoral epiphysis (n = 5), Meyer's dysplasia (n = 2), septic arthritis of the hip (n = 2), osteomyelitis of the acetabulum (n = 1), abscess of the psoas (n = 1), chondromatosis of the hip joint (n = 1), Ewing's sarcoma of the os pubis (n = 1), hip dysplasia (n = 1). Three patients who had synovitis developed Perthes' disease and were assigned to group II. The efficiency of ultrasound, scintigraphy and MRI as diagnostic tools was tested in the examination of painful hip. A capsular distension was present in 73 cases and showed a significant statistical difference (t-test, P < 0.001) in group I between affected and unaffected hips. There were no differences in the measurements of the epiphyseal and metaphyseal width in group I between the affected and the nonaffected side (t-test, P = 0.91, P = 0.57) and between the first sonographic evaluation at presentation and at the follow-up (t-test, P = 0.053, P = 0.75). MRI was performed, because of persistent joint effusion, in 10 cases in group I, and Perthes' disease was excluded. In group II the use of an MRI allowed the diagnosis in 89% of the cases. Sonographic examination, together with X-ray examination and serological testing, represent the first choices in the evaluation of a painful hip at presentation and in the follow-up of transient synovitis. MRI should always be performed when abnormalities are present at the clinical and sonographic examination, and when the X-ray does not allow a clear diagnosis.

Acetabulum↗
PubMed2006

Fungal infections of the spine.

UNLABELLED: Fungal infections of the spine are relatively uncommon. Fungi such as Coccidioides immitis and Blastomyces dermatitidis are limited to specific geographical areas whereas cryptococcus, candida, and aspergillus are found worldwide. Candida and aspergillus are normal commensals of the body and produce disease in susceptible organisms when they gain access to the vascular system through intravenous lines, during implantation of prosthetic devices, or during surgery. For the other fungi, spinal involvement usually is the result of hematogenous or direct spread of organisms from an initial pulmonary source of infection. Involvement of the vertebral bodies can lead to vertebral compression fractures and gross deformity of the spine. Spread of infection along the anterior longitudinal ligament can lead to psoas or paravertebral abscesses. Early recognition of the disease requires a high index of suspicion, proper travel history, and a detailed physical examination. Treatment relies on the prompt institution of appropriate pharmacotherapy and constant monitoring of clinical progress. Resistance to medical therapy, spinal instability, and neurologic deficits are indications for débridement and stabilization with spinal fusion. Prognosis depends on the premorbid state of the patient, the type of fungal organism, and the timing of treatment. LEVEL OF EVIDENCE: Level V (expert opinion). Please see the Guidelines for Authors for a complete description of levels of evidence.

Antifungal Agents↗
PubMed1983

Childhood diskitis: computed tomographic findings.

The spectrum of computed tomographic findings in seven children with diskitis is reported. Paravertebral inflammatory masses, intraspinal (epidural) soft-tissue extension with thecal sac deformity, and psoas involvement with abscess were demonstrated in 7/7, 6/7, and 1/7 patients, respectively. Plain radiographic findings of disk space narrowing and vertebral end-plate destruction were confirmed by CT in all cases. Follow-up CT in two patients revealed persistent bone destruction despite resolution of soft-tissue inflammation and clinical abnormalities. CT proved most useful in the diagnosis of early and atypical cases. The CT spectrum of childhood diskitis may simulate other diseases, including neoplasm, tuberculosis, and disk herniation. While CT is not routinely indicated in typical childhood diskitis, it may confirm the diagnosis in those patients with atypical clinical presentation or nonspecific plain radiographs, and exclude other lesions in patients unresponsive to routine treatment.

Adolescent↗