SEARCH · Search PubMed
Results for “Psoas Abscess”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
[Diagnostic value of the CT scan in suppurative abdominal lesions (author's transl)].
Computed tomography, a relatively non-aggressive method of radiological investigation, can establish diagnosis, and, more particularly, define the site of suppurative lesions in the peritoneal cavity, the retroperitoneal space, and in solid organs (liver, kidneys, spleen). This method was employed to explore the abdomen in 52 patients. Intraperitoneal suppurations were diagnosed in 15 cases after demonstration of a low density mass, which may contain clear pockets of gas or be limited by a higher density wall. In 4 cases, a retroperitoneal lesion was detected (psoas or perinephric abscess). A parenchymatous abscess was present in 6 cases, 4 in the liver, one in the kidneys, and one in the spleen. Using the angioscan technique, after a bolus injection of an iodised contrast medium, improved definition of the limits of the abscess can be obtained. Differential diagnosis of intraperitoneal suppurative lesions in cases of developing haematomas, or in the presence of an intrahepatic abscess, which may be confused with necrotic metastases or post-traumatic ischaemic foci, may be difficult.
Abscess cavity extending from the subarachnoid space to the paraspinal area and psoas muscle.
Explore the source record for details and available documents.
Primary retroperitoneal abscess complicated with septic arthritis of the hip.
Primary retroperitoneal abscess complicated with septic arthritis of the hip is an unusual disease. The insidious and occult nature of abscess coexistent with arthritis causes diagnostic delays, prolonged sepsis, and considerably higher morbidity and mortality. We herein present a case of gouty arthritis and avascular necrosis of the femoral head in a 41-year-old woman who complained of fever, right flank pain, body weight loss, swelling over her right lower limb, and 2 weeks of pain in the right hip. The computed tomographic scan showed a huge abscess (about 32 x 10 x 8 cm) over the right posterior pararenal space, with swelling of the right psoas, iliac, and obturator muscles. During surgery, the abscess was drained and sequestrectomy of the right hip was performed. Cultures of pus from the retroperitoneum and right hip showed Escherichia coil and Staphylococcus aureus. We review the literature and discuss possible causes.
Tuberculous abscesses in patients with AIDS.
Five cases of large tuberculous abscesses in patients with AIDS were observed over a 2-year period at the New York Veterans Affairs Medical Center. These cases represent 11.6% of the 43 cases of tuberculosis diagnosed in patients with AIDS during that period. The abscesses were located in the liver, abdominal wall, psoas muscle, mediastinum, and peripancreatic area. All patients presented with localized pain or swelling, and four of five patients had fever. The diagnosis was made on the basis of detection of abscesses on computed tomography (CT) and the results of culture of abscess material obtained by CT-guided aspiration. CT-guided therapeutic drainage was performed in two cases. Despite administration of therapy, two of five patients died of tuberculous infection. Formation of tuberculous abscesses appears to be a common complication of tuberculosis in patients with AIDS. This diagnosis should be considered for patients with AIDS who have fever and localized pain or swelling.
Extra-renal abscess in chronic hemodialysis patients.
AIM: Infectious disease represents one of the major causes of morbidity and mortality in hemodialysis patients. Extra-renal abscess constitutes a specific form of infection. The aim of this study was to evaluate and analyze the clinical characteristics of extra-renal abscess in chronic hemodialysis patients. METHODS: We retrospectively studied the extra-renal abscess among chronic hemodialysis patients in Chang Gung Memorial Hospital at Kaohsiung, Taiwan. The records of 2,168 chronic hemodialysis patients from October 1986 to January 2000, were studied. The clinical features were reviewed and analyzed. RESULTS: Sixteen patients who were enrolled during the study period developed extra-renal abscess. Ten of them were male. The mean age was 59.2 +/- 11.8 years old. More than half of the patients had diabetes (53.6%, 9/16). The locations of extra-renal abscess in these patients were liver (8/16), lung (5/16), spleen (1/16), perianal region (1/16), psoas muscle (1/16), and prostate (1/16). One patient had concurrent liver and spleen abscesses. All patients presented with fever and chills. Laboratory studies revealed leukocytosis and thrombocytopenia in 2/3 of the patients. The patients were associated with malnutrition status with lower serum albumin level (2.94 +/- 0.55 gm/dL) and lower nPCR (normalized protein catabolism rate; 0.84 +/- 0.11 gm/Kg/day) comparing to the other hemodialysis patients (albumin: 4.05 +/- 0.47 gm/dL; nPCR: 1.14 +/- 0.31gm/kg/day). There was no significant difference in kt/V between the patients with (1.28 +/- 0.34) or without abscess formation (1.47 +/- 0.36). The major causative pathogen was Klebsiella pnewnoniae. Parenteral antibiotic treatment is sufficient to treat most of the diseases, except 2 patients who needed surgical intervention. Twelve patients recovered after 2-3 weeks of treatment. CONCLUSIONS: The study indicated that extra-renal abscess is rare in chronic hemodialysis patients. The abscesses occurred mostly in liver. Diabetes mellitus and poor nutrition status were the important predisposing factors. Gram-negative bacilli, K. pneumoniae, were the major pathogen. Most of the patients responded to parenteral antibiotics and surgical draining.
Retroperitoneal collections--aetiology and radiological implications.
PURPOSE: Retroperitoneal collections related to the psoas, in the absence of pancreatitis, are uncommon. This study reviews the imaging, pathogenesis and management of retroperitoneal collections with particular emphasis on distinguishing imaging features and the role of percutaneous drainage. MATERIALS AND METHODS: Twenty-three retroperitoneal collections in 22 patients were reviewed in a 2-year period. Twenty-one patients underwent computed tomography (CT), with ultrasound (US) conducted in 14 and magnetic resonance imaging (MRI) in four. The clinical history and associated aetiological factors were noted. Methods of drainage were compared, pathological/microbiological results were recorded and the clinical outcome noted. RESULTS: The mean age of presentation was 46.9 years (range 18-85 years). There was a male to female preponderance (17 to 6). Eighteen collections proved to be abscesses with five haematomas confirmed. Of the abscesses, three were primary and 15 were secondary to spinal, gastrointestinal or renal disease. Escherichia coli was the commonest isolated organism followed by Mycobacterium tuberculosis. No haematomas were drained. Twelve abscesses were drained successfully by percutaneous methods; three were managed with antibiotics alone; three were managed surgically. CONCLUSION: Secondary abscesses predominate and investigation should be directed at excluding a gastrointestinal or renal source. Tuberculous disease remains a significant problem. Percutaneous drainage allows effective management, even in the presence of a secondary abscess.
[A case of extra-anatomic bypass for ruptured thoracoabdominal aortic aneurysm with tuberculosis].
Now aneurysmectomy and graft replacement is the most popular surgical method of aortic aneurysm, but there are many opinions about surgical methods and assist circulation for emergency operation of ruptured aortic aneurysm. We experienced the case of ruptured thoracoabdominal aortic aneurysm with tuberculosis, and rescued the patient by extra-anatomic bypass (EAB). A 60-year-old woman, who had been treated with tuberculosis for about 40 years, was operated on for cold abscess of her left psoas muscle by other orthopedic surgeons. At that time, massive bleeding happened, and she was transferred to us under diagnosis of ruptured thoracoabdominal aortic aneurysm. EAB, as emergency operation, was done because we considered it was dirty and dangerous to replace the prosthesis beside the abscess. The postoperative course was almost uneventful except the evidence of Gaffky's first stage. We considered EAB was an useful method for emergency cases and some infectious aortic aneurysms.
Case study: gluteal abscess due to Crohn's disease.
Spontaneous retroperitoneal abscess as a result of Crohn's disease does not always terminate at the psoas or iliac spaces. The abscess may continue downward breaching the obturator fascia. Passage through the sciatic foramina can result in a buttock or posterior upper thigh abscess. This possibility is illustrated in the case presented by a 40 year old female with toxemia and a fluctuant mass in the right gluteal area. Surgical drainage and control of the sepsis was followed by enterocutaneous fistula formation. Small bowel barium series demonstrated communication of the tracking abscess with the caput cecum. Surgical management consisted of formal ileocolectomy. The pathology report revealed Crohn's disease of the terminal ileum and right colon.
CT of the iliopsoas compartment: value in differentiating tumor, abscess, and hematoma.
OBJECTIVE: The iliopsoas compartment is an extraperitoneal space defined by the iliopsoas fascia; its major components include the iliacus, psoas major, and psoas minor muscles. Distinction of neoplastic, inflammatory, and hemorrhagic conditions of the iliopsoas compartment is often difficult, whether based on clinical evaluation or CT findings. The purpose of this study was to determine specific CT features that might help differentiate these three abnormalities. MATERIALS AND METHODS: We retrospectively reviewed CT scans of 44 patients who had abnormalities of the iliopsoas compartment (15 neoplasms, 21 abscesses, and eight hematomas). Final diagnoses were established by surgical biopsy (n = 14), percutaneous biopsy (n = 18), or clinical evidence (n = 12). Diagnoses were correlated with 11 CT features to determine findings that could be used to differentiate the three abnormalities. These included enlargement of the iliopsoas muscles; extent, margination, and attenuation of the lesion; presence of gas, calcification, bone destruction, fat infiltration, and fascial disruption; and associated fluid or adenopathy. The radiologist who interpreted the scans had no knowledge of the clinical findings. RESULTS: The most reliable CT features for each condition were as follows: irregular margins, 67% sensitive, 52% specific, and 57% accurate for neoplasms; low attenuation, 100% sensitive, 43% specific, and 70% accurate for abscesses; and diffuse involvement of the entire muscle, 88% sensitive, 78% specific, and 80% accurate for hematomas. Combinations of individual CT features did not improve the ability to differentiate the three conditions. CONCLUSION: Our results show that the efficacy of CT, when scans are interpreted without knowledge of the clinical history, is poor for differentiating iliopsoas neoplasms, abscesses, and hematomas.
[Limp as a presenting symptom of psoas muscle inflammation].
Inflammatory irritation of the psoas muscle in children is rare. The initial diagnosis may be difficult because of the similarity between the symptoms of psoas muscle inflammation and septic hip joint. We present a boy and a girl, both 3.5 years old, with psoas muscle inflammation, whose initial clinical and laboratory findings could be explained by either septic hip joint or osteomyelitis. Both presented with fever and limp. 1 developed an acute abdomen within 3 days and at operation a retrocecal periappendicular abscess was found. In the other, left lower quadrant, abdominal pain developed 4 days following admission and ultrasonic findings indicated a left psoas muscle abscess. We suggest that psoas muscle inflammation should be added to the differential diagnosis of limp in children. Early correct diagnosis can be established by proper physical examination, including rectal examination, and with the aid of diagnostic tools such as ultrasound, computerized tomography or both.
CT in the evaluation of complicated autosomal dominant polycystic kidney disease.
PURPOSE: We retrospectively reviewed the CT findings in 24 cases of autosomal dominant polycystic kidney disease (ADPKD) to assess the role of CT in the diagnostic work-up of patients with complicated ADPKD. MATERIAL AND METHODS: Twenty-four patients with ADPKD underwent unenhanced and contrast-enhanced CT for flank pain, haematuria, or fever. The images were retrospectively reviewed for presence of complicated cysts, their morphological features and associated findings in the perinephric space/retroperitoneum. RESULTS: Cyst haemorrhage was present in all patients, seen as high-density cysts, which were mostly bilateral. Most of these cysts had sharply outlined contours, sharp interfaces with adjacent renal parenchyma, imperceptible walls, and homogeneous density, and did not enhance following i.v. contrast administration. However, a few haemorrhagic cysts (9 cysts in 6 patients) showed inhomogeneous density (n=7), dependent layering of high-density blood leading to fluid-fluid level (n=2), and contour irregularity (n=3). CT revealed presence of cyst infection in 6 cases; the involved cysts were larger (average size 4.2 cm) than adjacent cysts, had only a mildly increased or near water density, and showed wall thickening and enhancement. Other findings included air within the infected cyst (n=1), thickening and enhancement of peri- and paranephric fasciae (n=5), and abscesses in the posterior paranephric space and adjoining psoas muscle (n=2). In 2 other patients, although CT suggested cyst infection because of presence of wall enhancement, diagnostic needle aspiration revealed only sterile haemorrhagic fluid. In 1 case, CT revealed a soft tissue density enhancing mass in one of the cysts; this proved to be a renal cell carcinoma by fine-needle biopsy. Calculi were observed in 7 patients, and cyst wall calcification in 11 cases. CONCLUSION: A combination of unenhanced and contrast-enhanced CT allows correct diagnosis and differentiation amongst the various complications affecting patients with ADPKD. However, in a small subgroup of patients, it may not be possible to differentiate between haemorrhage and infection; such cases require diagnostic needle aspiration for diagnosis.
[Percutaneous treatment of abdominal collections. Apropos of 135 cases].
The authors reviewed 135 abdominal collections, collected at the Radiologic Central Service over four years. The average age of the patients was 40 years. The abscesses sit especially in the liver (54 cases) and the psoas muscle (43 cases). The percutaneous management was guided by ultrasonography in all the cases. The results were successful in 74%. Only 15 cases needed surgical therapy. The literature results are similar. The authors underline the percutaneous treatment interests, its efficacy, its complications and their therapy.
Retroperitoneoscopic ureterolithotomy for impacted ureteral stone.
Retroperitoneoscopic ureterolithotomy was successfully performed in two patients with impacted upper ureteral stone. The retroperitoneal space was extended using a balloon dissector and four ports were established into the retroperitoneal space according to Gaur's procedure (1993). The impacted ureteral stone was removed after the ureter was incised using a hook electrode. An indwelling splint or stent was placed in the ureter. The incised ureter was not sutured and an indwelling drain was placed in the retroperitoneal space. Urine leakage ceased within 3 days postoperatively. With regard to complications, the first patient developed wound infection caused by methicillin-resistant Staphylococcus aureus and the second patient had abscess formation in the psoas muscle. Retroperitoneoscopic ureterolithotomy should be useful as an alternative treatment for impacted ureteral stones because it involves minimal postoperative pain.
[Percutaneous sonographically guided fine-needle puncture and drainage of pyogenic abscesses].
Between January 1988 and April 1991, a total of 79 ultrasound-directed percutaneous punctures and (or) drainage of abscesses were performed on 31 patients (15 men, 16 women; mean age 63 [31-85] years). There were 14 hepatic, 4 splenic, 4 abdominal wall and 3 pancreatic abscesses, and one each subphrenic, presacral, retrocaecal, ischiorectal, pulmonary and in the psoas. After ultrasound localization of the abscess a fine-needle puncture was performed, after which the abscess cavity was emptied as much as possible or, in abscesses larger than 5 cm in diameter, drained through a pig-tail catheter (6-8, 4 F). Several punctures were needed in 16 patients, while in 15 a percutaneous drainage over 2-8 days was necessary. Treatment was successful after 4-17 days in 25 patients. One patient died in septic shock. Operative intervention after diagnostic puncture was undertaken in 5 patients. There were no complications related to the method. In 11 patients the further course was determined by an underlying malignant disease. No recurrence has been noted (4-36 months after treatment) in 14 patients with a benign underlying disease. Percutaneous puncture and drainage of pyogenic abscesses is a technically simple method which achieves good results.
Retroperitoneal actinomycosis.
A 44-year-old man had an abscess involving the left psoas muscle and inferior pole of the left kidney associated with characteristic sulfur granules of actinomycosis. The patient was treated with surgical drainage and debridement and with intensive and prolonged penicillin therapy, resulting in a clinical cure and resolution of both the hydronephrosis and the retroperitoneal mass.
Surgical strategy for spondylodiscitis due to Candida albicans in an immunocompromised host.
A 44-year-old woman receiving systemic chemotherapy for cerebellar medulloblastoma developed thoracolumbar spondylodiscitis due to Candida albicans associated with abscesses in the bilateral psoas muscles. As long-term medical therapy with fluconazole was not effective, radical removal of the affected lesions and anterior bone grafting were performed. Corpectomy of the infected vertebra with autologous bone grafting and removal of the psoas muscle were performed via the right transthoracic retroperitoneal approach. Additional posterior instrumentation was not used. Two years after the operation, the patient was doing well, and systemic chemotherapy for medulloblastoma has restarted. Corpectomy with radical resection of surrounding infectious tissues for C. albicans spondylodiscitis in an immunocompromised host should be performed when conservative medical treatment is not successful. Further instrumentation surgery might be necessary to prevent further deformity of the spine as the second surgery.
[Candida albicans spondylodiscitis].
Infections by Candida sp. have increased notably and cause not only local but also systemic infections. It is rarely mentioned as an etiologic agent of osteomyelitis. Two cases of candidiasic spondylodiscitis are presented with the first being in a 33 year old intravenous drug using male who consulted for mechanical lumbar pain. Spondylodiscitis L2-L3 was observed upon radiological study. Aspiration puncture was carried out and the cultures were negative. Surgical biopsy was performed with spondylodiscitis and an abscess in the spine being observed. C. albicans was isolated in the culture. Pathological study confirmed the diagnosis. Cutaneous and sternocostal involvement was also concommitantly presented. The patient was treated with amphotericin B with a favorable evolution. The second case was in a 35 year old male with burns over 65% of his body due to a laboral accident. Three months after admission the patient presented lumbar pain irradiating to the groin and thigh. Bone destruction of the second lumbar vertebra and an abscess of the right psoas were observed upon CT scan. Puncture biopsy was performed and C. albicans was isolated. Histopathologic study demonstrated osteomyelitis by Candida sp. Treatment with amphotericin B was started. Posteriorly urea and creatinine was raised. Treatment was continued with fluconazole with good therapeutic response.