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PubMed2003

[Psoas abscess in children based on a series of 18 cases].

OBJECTIVE: Psoas abscess is very rare in children and raises problems concerning the clinical and aetiological diagnosis. The authors describe the characteristics of this rare disease and emphasize the role of imaging in the diagnostic approach and therapeutic management. MATERIAL AND METHOD: The authors report a series of 18 cases children aged 11 months to 13 years treated between 1988 and 2000 in the Monastir department of paediatric surgery. The time to diagnosis ranged from 4 days to 1 month. The clinical features comprised fever, abdominal pain and functional impairment of the homolateral lower limb in 17 cases. RESULTS: Ultrasound was performed systematically and established the diagnosis in 17 cases. Computed tomography, performed in 13 cases, confirmed the diagnosis and demonstrated the aetiology in 3 cases. The microorganism was isolated in 16 cases (Staphylococcus aureus in 13 cases). An aetiology was identified in 4 cases: acute appendicitis, Potts disease, sacro-iliitis and perirenal abscess. Treatment comprised systematic antibiotic therapy combined with drainage of the abscess in 16 cases, which was performed surgically in 4 cases and percutaneously in 12 cases. CONCLUSION: The prognosis of psoas abscess in children is generally favourable. CT- or ultrasound-guided percutaneous drainage is a valuable alternative to surgery, which must be reserved for cases of failure of percutaneous drainage.

Adolescent↗
PubMed1990

Primary psoas abscess. An often insidious infection.

Psoas abscess is most often caused by infection with Staphylococcus aureus. Classic symptoms are localized pain, persistent fever, and a limp or flexion problem of the hip. Diagnosis can be confirmed by ultrasound or computed tomographic scan. Appropriate treatment consists of drainage of the abscess and antibiotic therapy.

Abscess↗
PubMedDate not supplied

[Pyonephrosis complicated by a pyogenic psoas abscess. Apropos of a case].

Psoas abscess of pyogenic origin developed secondary to renal infection in a patient with coralliform lithiasis, a favorable outcome being obtained after nephrectomy and drainage of abscess. Clinical diagnosis is difficult but ultrasound and CT scan imaging provide useful data. Other causes of pyogenic abscess are discussed, the most frequent origin being digestive disease.

Abscess↗
PubMed2003

[A case of psoas abscess caused by Candida albicans].

We report a rare case of psoas abscess caused by Candida albicans. A 59-year-old man with diabetes mellitis presented with right flank mass. Computed tomography (CT) showed a psoas abscess. Needle aspiration of the right flank mass revealed pus which was proved to be C. albicans by culture. The literature is briefly reviewed.

Candidiasis↗
PubMed2006

[Melitococcal psoas abscesses: study of three cases and review of the literature].

Vertebral involvement is a common complication of brucellosis in adults. However psoas abscess related to brucellar spondylitis have rarely reported. The purpose of this report is to describe three cases of bilateral psoas abscess identified during workup for brucellar spondylitis. Medical imaging was helpful in confirming diagnosis of these fluid collections. Epidemiological, clinical, radiological and serological findings were consistent with melitococcal etiology. Treatment was based on a combination of antibiotics (rifampicine-doxycycline) and abscess evacuation by percutaneous drainage, needle aspiration or open surgery. Outcome was favourable. Brucellar psoas abscess is uncommon. Most caseare discovered coincidentally during investigation of melitococcal spondylitis. Management usually consists of fluid drainage and appropriate antibrucellar therapy. Prognosis is favourable.

Adult↗
PubMed1998

Primary ilio-psoas abscess extending to the thigh in a neonate: US, CT and MR findings.

Psoas abscess in children, and especially in neonates, is an uncommon condition which is difficult to diagnose clinically. The US, CT and MR findings of a psoas abscess in a neonate, which extended to the thigh, are reported. Imaging was helpful in revealing the abnormality, in demonstrating its extension and in determining its nature. The child was treated conservatively and the abscess resolved, leaving atrophy of the psoas muscle.

Humans↗
PubMed2003

Molecular characterization of a strain of group a streptococcus isolated from a patient with a psoas abscess.

We report the first case of a primary group A streptococcus (GAS) psoas abscess in a 31-year-old woman. The psoas abscess was preceded by an episode of acute pharyngitis. The M-protein gene (emm) and streptolysin S structural gene (sagA) were present in the isolate, with no significant amino acid differences from previously described sequences of M1 GAS isolates. Multilocus sequence typing (MLST) showed that the isolate belonged to MLST sequence type (MLST-ST) 28, the predominant MLST-ST associated with invasive disease caused by M1 isolates.

Adult↗
PubMed2006

Seventy cases of non-tubercular psoas abscess at a rural referral centre in South Bengal.

About 70 patients admitted with psoas abscess are reviewed. The ratio of non-tubercular to tubercular psoas abscess was 6:1 and left-to-right psoas involvement was 1.6:1. Iliac fossa mass and neutrophilic leucocytosis were found in all the patients without any underlying bony involvement. Ultrasonography and needle aspiration of pus were followed by surgical drainage. Staphylococcus aureus was the most common organism cultured.

Academic Medical Centers↗
PubMed1995

Multiple psoas abscesses after posterior spinal fusion.

STUDY DESIGN: A case of multiple psoas abscesses after Dove lumbar spine fixation is reported. OBJECTIVES: To review the diagnosis and treatment of deep infection after internal spinal fixation. METHODS: The possibility of septic complications after spinal surgery that may present with a degenerative pattern is examined. The clinical and computed tomographic findings of a psoas abscess are recalled. RESULTS: Surgical drainage of the purulent collection was performed along with prolonged parenteral antibiotic treatment. CONCLUSION: Infection should be considered as a cause of recurrence of pain after internal fixation of the lumbar spine.

Female↗
PubMed2000

Ilio-psoas abscess in neonates: treatment by ultrasound-guided percutaneous drainage.

Ilio-psoas abscess is rare in neonates and is usually treated by surgical drainage. We report two cases of ilio-psoas abscess in 15- and 21-day-old infants successfully treated by US-guided percutaneous drainage as a supplement to antibiotic therapy. Clinical improvement was observed within 24-48 h of drainage and subsequent imaging demonstrated resolution of the abscess cavity. The analysis of these cases and of those previously reported indicates that imaging is essential for diagnosis. In neonates, US-guided percutaneous drainage may represent the first-choice treatment of this disease in association with antibiotic therapy.

Age Factors↗
PubMed1992

[Psoas abscess: diagnostic and therapeutic usefulness of echography and computerized tomography].

BACKGROUND: Psoas abscess (PA) is a clinically infrequent entity. The abscess may form spontaneously (primary PA) or as a complication of contiguous infection (secondary PA). The use of ultrasonography (US) and computerized tomography (CT) facilitates diagnosis and treatment of a disorder which previously required surgery. METHODS: Nineteen cases of PA diagnosed over the last 7 years were retrospectively studied. Confirmation of diagnosis was established by exteriorization of pus with US, CT or during surgery. RESULTS: Three primary PA (16%) and 16 secondary PA (84%) were diagnosed. The foci of origin of the secondary PA were: urologic (50%), rachydeal (25%), gastrointestinal (12.5%) and iatrogenic lumbar infection (12.5%). The most frequent germs in the primary PA were: Staphylococcus aureus (67%) and in the secondary PA, enterobacteriae (50%). The diagnostic profitability of US was 41% (7/17) and for CT was 100% (15/15). Percutaneous drainage was performed in 9 patients which failed in 2 cases due to compactness of pus (22%) and in another 2 because of undiagnosed osteomyelitis (22%). Two patients (10%) with underlying disease died despite adequate medical-surgical treatment. CONCLUSIONS: Psoas abscess were secondary in 84% of the patients studied with most being due to enterobacteriae. The diagnostic profitability of computerized tomography was greater than that of ultrasonography (100% vs 41%). Percutaneous drainage is a valid therapeutic alternative. Relapse observed in this study was due to previously undiagnosed osteomyelitis.

Adolescent↗
PubMed2000

Psoas abscess secondary to discitis: a case report of conservative management.

We report a case of secondary psoas abscess in a 37-year-old man with a 3-week history of severe low backache managed conservatively without surgical drainage. Apart from bilaterally restricted straight leg raising (<70 degrees), his neurologic examination was within normal limits. Magnetic resonance imaging showed discitis of the L3-L4 space and a left-sided secondary psoas abscess. Aspiration biopsy of the abscess material under radiologic control isolated Staphylococcus aureus, which responded to appropriate antibiotic therapy with complete resolution. A high index of suspicion is necessary for diagnosis of psoas abscess, which should be considered in patients with pyrexia and backache with a neurologic examination that is otherwise normal. We discuss the recommendations for surgical and nonsurgical approaches.

Abscess↗
PubMedDate not supplied

[Psoas abscess: considerations on 6 cases].

We present six cases of psoas abscess, three primary and three secondary. The etiologic, pathogenic and therapeutic considerations are outlined. Staphylococcal infections prevail in the primary abscesses. The diagnostic difficulties are considerable but nowadays are facilitated by echography and TAC. In the secondary ones, the psoas abscess is an epiphenomenon of a more easily recognised clinical syndrome. It is surprising how these septic processes are increasingly placed in the hands of urologists in recognition of their mastery of retroperitoneal surgery.

Abscess↗
PubMed2003

Metastatic carcinoma of the cervix presenting as a psoas abscess in an HIV-negative woman.

A case of advanced carcinoma of the cervix presenting as a psoas abscess is described. This unusual presentation has been reported in association with AIDS but is extremely rare in HIV-negative women. This case report emphasises the importance of awareness of unusual causes of the psoas abscess in an era when the classical tuberculous abscess is fast disappearing.

Adult↗
PubMed2004

Penetration of isoniazid, rifampicin and pyrazinamide in tuberculous pleural effusion and psoas abscess.

SETTING: Tuberculosis Centre, University Medical Centre, Groningen, The Netherlands. OBJECTIVES: To study intralesional concentrations of isoniazid (INH), rifampicin (RMP) and pyrazinamide (PZA) in tuberculous pleural effusions and psoas abscesses, and to compare these to reference serum values and minimal inhibitory concentration (MIC). DESIGN: Intralesional concentrations were measured 2 h after drug administration (six pleural effusions, 10 psoas abscesses). RESULTS: A wide range of concentrations was found for pleural effusions and psoas abscesses. Concentrations were below MIC values in none of 15 patients for INH, in two of 13 for RMP, and in eight of nine for PZA. The Cmax:MIC ratio was always >4 for INH, in four of 13 for RMP, and in none of nine for PZA. In 5/8 patients receiving all three drugs, both RMP and PZA had Cmax:MIC ratios <4, indicating sub-therapeutic drug levels. CONCLUSION: Penetration of INH was always sufficient, penetration of RMP mostly below the desired ratio, and for PZA on average 10 times too low. Five of eight patients on all three drugs had Cmax:MIC ratios <4. This indicates intralesional sub-therapeutic drug levels for RMP and PZA, and local monotherapy with INH. This could induce drug resistance. Drainage as additional therapy seems indicated.

Adolescent↗
PubMedDate not supplied

Primary psoas abscess: report of one case.

A 6-year-old girl was admitted to our hospital with the problems of persistent fever, limping gait, and right hip pain. On physical examination, flexion of the right hip with limitation of the range of motion was noted. Tenderness over the right inguinal area was also elicited. Pyogenic arthritis of the right hip was suspected. Aspiration of the right hip joint was negative. Two days later, a careful examination revealed that the Patrick's test was negative and a local tenderness on the right lower abdomen was found. Laparotomy was performed under the impression of retroperitoneal abscess. The postoperative diagnosis was psoas abscess. After surgical drainage and antibiotics therapy, she was discharged 2 weeks later with good condition.

Child↗
PubMed1998

Rectal drainage: unusual evolution of a psoas abscess.

We report two cases of primary psoas abscess in two patients of 15 months and 4 years of age. As the first case showed the natural history of this process the second one was large enough to produce a huge ureterohydronephrosis and to drain through the rectal wall to the rectum spontaneously, although this natural way did not achieve complete drainage. Both were treated by open drainage and systemic antibiotics with good response. They were discharged at the 7th and 12th postoperative day. 5 months later no complication has come up. Etiological, clinical and therapeutic aspects of this unusual pathology are reviewed.

Child, Preschool↗
PubMedDate not supplied

[Primary psoas abscess in a child. Case report and review of the literature].

Primary psoas abscess is an uncommon disease. In children, clinical manifestations is often inspecific leading to diagnostic delay. The authors relate a primary pyogenic abscess of the psoas muscle in a 7-year-old girl with secondary septic arthritis of the hip. Confirmation of diagnosis was established by computerized tomography (CT) of the abdominal and pelvic areas. A review of the literature is presented about clinical manifestations, pathogenesis, differential diagnosis, etiology, diagnostic and therapeutic management of this infrequent entity.

Arthritis, Infectious↗