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PubMed1983

Psoas compartment disease studied by computed tomography. Analysis of 50 cases and subject review.

Fifty patients with disease involving the psoas compartment were analyzed. There were 27 patients with inflammation, 17 with tumor, and 6 with hemorrhage. In all but 3 cases the disease did not originate in the psoas but spread there from neighboring structures. Disease processes followed the fascial planes in patients with abscesses and hemorrhage but were less predictable with tumors. All three types of lesions were similar radiographically and were often indistinguishable. Asymmetry of the muscle mass, regions of decreased density, and opacification of fat in the peri- and pararenal compartments were the most frequent signs of disease. Computed tomography is recommended as the diagnostic procedure of choice.

Abscess↗
PubMed1991

Abscess of the iliopsoas muscle diagnosed by magnetic resonance imaging and ultrasonography.

We have reported a case of abscess of the iliopsoas muscle, in which a limp and hip pain pointed toward pathology of the hip. The diagnosis in such cases may be difficult unless there is close attention to the clinical history and a good physical examination is obtained. One ultrasonographic examination of the hip in such a patient, subtle differences between the iliopsoas muscles should alert the radiologist to examine the psoas muscle. Ultrasonography is instrumental in demonstrating the solid or cystic nature of the iliopsoas mass, while MRI depicts the extent and proximity of adjacent organs. Once an iliopsoas abscess is diagnosed, treatment includes parenteral antibiotics and drainage.

Abscess↗
PubMed1997

Abdominal actinomycosis: barium enema and computed tomography findings.

A case of abdominal actinomycosis is described in a woman with recurrent right lower abdominal pain and low-grade fever without history of appendectomy. Past history included the use of an intrauterine device (IUD) until 10 years before manifestation of these symptoms. We followed up the patient, via diagnostic imaging, for 7 months. On initial barium enema, a polypoid lesion was visualized at the bottom of the cecum and there was constriction of the sigmoid colon; the appendix was not seen. Seven months later, poor extension at the cecum, severe constriction in the sigmoid colon, and narrowing of the terminal ileum were also visualized. On computed tomography (CT), the lesion was initially localized only in the ileocecal region adjacent to the sigmoid colon. After 7 months, the lesion had infiltrated adjacent anatomic components and showed direct infiltration of the pelvic space. Differential diagnosis was difficult, as it was not obvious whether this was a pelvic abscess due to inflammation or appendiceal carcinoma. Laparotomy was performed. Macroscopically, the lesion was not limited to the ileocecal region, but involved the right ureter, tubes the Fallopian and ovary, bladder, psoas muscle, and abdominal wall. Pathology findings showed, chronic inflammatory tissue with evidence of actinomycosis. Although previous reports have described a lack of specific findings in this disease. When actinomycosis is suspected, CT is recommended to define its extent.

Abdominal Abscess↗
PubMed1984

Lumbar artery pseudoaneurysm: CT demonstration.

A psoas mass in a patient with a history of penetrating trauma to the area was demonstrated by computed tomography (CT) to represent a lumbar artery pseudoaneurysm surrounded by hematoma. This report emphasizes the importance of recognizing the anatomic position of the lumbar arteries on CT images and considering the possibility of pseudoaneurysm in the differential diagnosis of post-traumatic psoas masses.

Abscess↗
PubMed2001

The hip or not.

Pathologies within the ileopsoas compartment can present as hip pain and as such can be mistaken for diseases of the hip joint. Radiological investigations are useful in helping to differentiate between these pathologies.

Abscess↗
PubMed1980

CT of acute pancreatitis: interim assessment.

a retrospective review of 102 ptients with the clinical diagnosis of acute pancreatitis undergoing computed tomographic (CT) evaluation during a 9 month period revealed 32 patients with abnormal CT scans. All 32 had enlargement of the pancreas. The extent of inflammatory process on these patients was examined. Twenty patients exhibited a phlegmonous mass extending into the region of the lesser sac. There was involvement of the left anterior pararenal space in 13 (the right in three and both in four). Eight patients demonstrated involvement of the posterior pararenal space, and in seven of these the inflammatory process extended down the psoas muscle into the pelvis. Five patients had involvement of the transverse mesocolon and small bowel mesentery. Eight patients developed a pseudocyst during the acute phase of the disease, 11 developed a pancreatic abscess, and two showed evidence of pancretic hemorrhage. This experience prompted a prospective study of the clinical course of acute pancreatitis relative to the extent of disease as recognized by CT.

Abscess↗
PubMed1981

[Pediatric retroperitoneal iliac abscesses (author's transl)].

11 cases of retroperitoneal iliac abscesses are reported in patients under seven years of age. Causes have been: sepsis in 2 cases, lumbar traumatism in 1, perforation of the iliac vein in 1, pararenal abscess in 1, following debridement of iliac adenitis in one child and by appendicular mass in another case. The etiology was unknown in the remaining cases. Gram positive germs such as Staphylococcus and Streptococcus predominated in the exudate cultures. The most important clinical manifestations have been: fever, painful mobilization of the psoas, pain in the iliac fossa, limping and antiallergic scoliosis. Among radiological findings obliteration of the psoas line, mass in the iliac fossa, ureteral displacement and vesical compression were the most outstanding. Breathing x-rays and echography were diagnostic procedures in our cases. Diagnosis and differential diagnosis are commented, together with treatment. Authors consider that surgical debridement and drainage and administration of antibiotics are the ideal therapeutical procedures in these processes.

Abscess↗
PubMed1999

Primary iliac muscle abscess due to Staphylococcus aureus.

A 55-year-old man presented with a 3-day history of lower back pain and right thigh pain. A diagnosis of discogenic pain had been made at two other hospitals. He had been admitted to a medical center for acute hepatitis 5 months prior to this admission. Large doses of parenteral hydrocortisone were used for 13 days to treat acute hepatitis. At the present admission, he was unable to stand and refused to move his right leg. There was mild tenderness in the right lower abdomen on deep palpation. Passive flexion and rotation of the right hip produced mild pain, while passive extension of the right hip produced severe pain and resistance. The Patrick test was positive and the psoas sign was present on the right side. The erythrocyte sedimentation rate (ESR) was 66/hr. The C-reactive protein (CRP) level was 0.161 g/L. Abdominal sonography showed a lobulated mass in the right iliac fossa. Magnetic resonance imaging showed severe swelling of the right iliac muscle with a central heterogeneous mass. Debridement, drainage of the abscess, and application of a septopal chain were performed via an anterior retroperitoneal approach, and parenteral cephazolin and gentamicin were administered. A culture of the abscess grew Staphylococcus aureus. The ESR and CRP concentrations decreased to within the normal ranges 3 weeks later. Awareness of this disease entity, careful physical examination, and appropriate imaging studies such as ultrasonography and magnetic resonance imaging are key to making a correct diagnosis.

Abscess↗
PubMedDate not supplied

Obturator internus muscle abscess in children.

The authors describe four cases of obturator internus muscle (OIM) abscess in children, including their clinical presentations and treatment. This was a retrospective chart review. Children and adolescents younger than 18 years discharged between July 1, 1985, and September 30, 1998, from Brenner Children's Hospital with the diagnosis of muscle abscess or pelvic abscess were identified. A total of 56 patients were identified with the diagnosis of muscle abscess or pelvic abscess. OIM abscess was defined by radiologic findings of an inflammatory process with fluid collection in the OIM, along with the clinical findings suggestive of an OIM abscess. Four of the patients met the definition of OIM muscle abscess. The common presenting features were fever, limp, and hip pain. Computed tomography or magnetic resonance imaging was diagnostic in all four patients, and Staphylococcus aureus was the causative agent in each. All the patients recovered, one after surgical drainage and the other three after antimicrobial therapy alone or with needle aspiration. The presentation of OIM pyomyositis is similar to that of psoas muscle pyomyositis and other infectious processes of the pelvis and hip. The S. aureus is the most common etiologic agent but not the only one reported. Most patients can be managed without open surgical drainage, but needle aspirations may be helpful both therapeutically and diagnostically.

Abscess↗
PubMed1981

[Perinephritic abscesses: a review of 50 cases (author's transl)].

Accumulation of pus in the perinephritic cavity often gives rise to doubtful clinical manifestations, which hinder and delay prompt diagnosis of this severe process. The clinical, biological, radiological and therapeutic characteristics of 50 cases are reviewed; all were confirmed by either surgery or necropsy. The most frequent clinical manifestations were fever, lumbar pain and signs of localized inflammation. Biological data showed ESR elevation and left shift of leukocytes as the most constant finding. Pyelograms were abnormal in 90% with blurring of the psoas and contour of the kidney the most frequent finding. Gram-negative organisms were frequently isolated, with staphylococci accounting for 10%. Only surgical treatment had a definite effect on evolution. The mortality rate was high, due to incorrect or delayed diagnosis.

Abscess↗
PubMed1986

Thigh abscess. An uncommon presentation of intraabdominal sepsis.

Abscesses of the thigh are rare and, although easily diagnosed, their cause is often obscure. We present two cases of thigh abscesses which resulted from the extension of intraabdominal sepsis. A review of the literature reveals only 46 previously reported cases. The underlying pathologic abnormality is usually a retroperitoneal perforation of a colorectal neoplasm or diverticular disease, whereas origin from the small bowel or appendix is distinctly less common. Routes of extension of infection into the thigh can be either direct, through the subcutaneous tissues, or through naturally occurring defects in the abdominal wall. These include: (1) along the psoas muscle deep to the inguinal ligament; (2) through the femoral canal; (3) by way of the obturator foramen; and (4) through the sacrosciatic notch. The two cases presented are unusual in that they both followed radical cystectomy with lymph node dissection, which opens up these natural avenues to the spread of intraabdominal infection. The overall mortality in the literature is high (53 percent), but recognition of an abdominal source and appropriate treatment combined with local drainage of the thigh abscess appears to improve survival.

Abscess↗
PubMed2004

[Spondylodiscitis caused by a strain of Staphylococcus aureus, in vitro sensitive to penicillin].

The case history of a man referred to our department with the diagnosis of purulent meningitis; actually, he presented spondylodiscitis of the lumbar spine with the infection spreading into the spinal canal and the left psoas muscle. The disease was caused by a strain of Staphylococcus aureus, which in vitro was sensitive to penicillin. However, treatment with crystalline penicillin in combination with ciprofloxacin failed. The paper suggests a differential diagnosis permitting to distinguish a typical purulent meningitis and an abscess in the spinal canal. The authors also discuss the suitability of administering penicillin in staphylococcal sepsis caused by a sensitive strain. The authors do not recommend crystalline penicillin in the management of severe staphylococcal infections even in cases, where the isolated S. aureus strain is really sensitive to penicillin.

Discitis↗
PubMed2000

Pyomyositis in a 5-year-old child.

We present a case of pyomyositis in an otherwise healthy 5-year-old child that underscores the potential for serious, life-threatening complications. Pyomyositis of the gluteal, psoas, and iliacus muscles was associated with osteomyelitis, septic arthritis, a large inferior vena cava thrombus, septic pulmonary emboli, and eventual pneumonia. Primary pyomyositis is a purulent infection of striated muscle thought to be caused by seeding from a transient bacteremia. The focal infection typically forms an abscess that generally responds to intravenous antibiotics and occasionally requires adjunctive computed tomography-guided aspiration and drainage. This localized infectious process rarely produces further sequelae unless treatment is delayed. Pyomyositis is rare in healthy individuals and requires a high clinical suspicion in patients who present with fever, leukocytosis, and localized pain.

Abscess↗
PubMedDate not supplied

Fine needle aspiration study of metastatic mixed adenosquamous carcinoma of the renal pelvis. A case report.

The findings in a fine needle aspirate of a psoas area metastasis from a mixed adenosquamous carcinoma of the renal pelvis are presented. The primary renal tumor is apparently the fourth such case reported in the literature; the pathogenesis of such tumors is briefly reviewed. The value of fine needle aspiration in excluding a clinically suspected abscess and in allowing a specific diagnosis of malignancy is emphasized.

Adenocarcinoma↗