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PubMed2002

Psoas abscess as the initial presentation of bladder cancer.

A 43-year-old man presented with left leg pain and an abdominal mass. Sonography and cystoscopy showed a bladder tumour obstructing the left ureteral orifice. The left kidney became nonfunctional. Computerized tomography suggested psoas abscess. Nephrectomy was done. Tumoral cells identified at cytological examination of psoas abscess but they were not found in the pyonephrotic kidney's pus. The patient declined further therapy and died 3 months postoperatively. This is the first case of bladder cancer presenting initially with psoas abscess.

Adult↗
PubMed1995

[Psoas abscess caused by Salmonella enteritidis: presentation of a case].

The psoas abscess is an entity of infrequent occurrence in daily clinical practice. Many pathogens have been related with the genesis of this focal infections, but it can be said nowadays that the Staphylococcus aureus is more often involved in them. We present the case of a male aged 26, with a culture of purulent drained material, where Salmonella enteritidis, a microorganism of exceptional presentation in this pathology, was isolde. Moreover, some hypothesis have been proposed about the possible physiopathology and the current state of the diagnostic and therapeutic techniques in these processes is revised.

Adult↗
PubMed2002

[[Primary psoas abscess. Presentation of 3 cases].

OBJECTIVE: To present 3 cases of primary abscess of the psoas muscle. The clinical features, diagnostic tests, treatment and outcome are discussed. METHODS/RESULTS: Three patients that presented with fever and pain referred to the renal and/or iliac fossa are described. Physical examination showed psoas involvement in only one patient. Among the complementary tests performed, ultrasound demonstrated the abscess in one of the cases; the definitive diagnosis was made by contrast-enhanced CT. One of the cases was treated only with antibiotics while the other two cases were treated with CT-guided percutaneous drainage and appropriate antibiotic therapy. CONCLUSIONS: Psoas abscess is an uncommon pathology whose presenting features are usually unspecific. CT with contrast enhancement is considered to be the technique of choice for the diagnosis and to corroborate the resolution of the condition. Recently, the use of CT or US-guided percutaneous drainage has replaced surgery as the initial therapeutic approach for this condition.

Adult↗
PubMed2003

Nocardia farcinica as the causative agent in a primary psoas abscess in a previously healthy cattle inspector.

A 42-year-old, previously healthy cattle inspector presented with a 7-day history of fever, a painful left knee, malaise and muscular pain. He did not suffer from an underlying disease, nor was he immunocompromised. After 12 days of hospitalization, a unilocular abscess in the left psoas muscle was diagnosed. Nocardia farcinica was isolated from the aspirate. No connection with his work could be demonstrated. The patient was successfully treated with trimethoprim-sulfamethoxazole for 11 months.

Adult↗
PubMed2005

Nalidixic acid-resistant Salmonella enterica serotype Typhi presenting as a primary psoas abscess: case report and review of the literature.

We report an unusual case of Salmonella enterica serotype Typhi presenting as a primary psoas abscess. The isolate tested susceptible to ciprofloxacin but resistant to nalidixic acid in vitro, a pattern associated with fluoroquinolone therapeutic failures. We review the literature for serovar Typhi psoas abscess in the absence of bacteremia and discuss the importance of identifying isolates with reduced susceptibility to fluoroquinolones.

Adult↗
PubMed1996

[Psoas abscess: diagnostic dilemma in childhood].

A series of 16 children diagnosed as having a psoas abscess or deep iliac lymphadenitis seen over a 25-year period (1970-1994) is presented. 10 were treated conservatively while 5 were drained surgically and 1 percutaneously under imaging guidance. The presenting signs and symptoms may mimic the frequently seen entities, acute appendicitis and acute hip arthritis. Lower abdominal and inguinal pain, limp, fever and increased white count are common in all of these conditions. Accurate differential diagnosis is necessary to avoid unnecessary surgery due to a wrong diagnosis. Ultrasonography is preferred for diagnosis. Antibiotic therapy should be instituted immediately, aimed primarily at Staphylococcus aureus, the most common causative agent, although other organisms may be implicated. When a psoas abscess has been diagnosed, surgery and drainage are indicated. One of the preferred approaches is percutaneous drainage under imaging guidance. Convalescence is usually rapid and without late sequelae.

Anti-Bacterial Agents↗
PubMed1987

Hip flexion deformity secondary to acute pyogenic psoas abscess.

The data from ten patients who underwent incision and drainage of an acute pyogenic abscess were studied with respect to the presence of an associated hip flexion deformity prior to incision and drainage of the abscess, bacteria cultured intraoperatively, treatment of any persistent hip flexion deformity postoperatively, and any additional sequelae noted at an average follow-up of seven years (range, one to 17 years). Six of the ten patients presented with an associated hip flexion deformity. In three patients, the deformity had resolved spontaneously and completely--in one by the third postoperative day and in two by the 45th postoperative day. Follow-up of these patients at up to 17 years revealed no residual flexion deformity. The flexion deformity in two of the six patients improved following incision and drainage, but residual flexion deformities of 10 degrees and 15 degrees were noted at three- and six-year follow-up, respectively. The sixth patient was treated with skin traction both preoperatively and postoperatively, but it was ineffective in totally correcting the deformity. Follow-up of this patient at one year revealed a residual 15 degrees hip flexion deformity. All six patients had normal ambulation at follow-up examination. Bacteria cultured intraoperatively did not appear to affect either the initial development of the flexion deformity or the time to resolution following incision and drainage of the abscess. Of 183 patients with an acute pyogenic psoas abscess reviewed in 14 series from the literature, 96% (176/183) presented with an associated hip flexion deformity. A hip flexion deformity in a patient with fever and pain on attempted extension of the thigh is therefore a reliable sign for the diagnosis of an acute pyogenic psoas abscess. Treatment may be indicated for a persistent deformity following incision and drainage. Skin traction is the most commonly used and successful method of treatment. Persistence of the hip flexion deformity postoperatively may be secondary to fibrosis within the psoas sheath or actual substance of the muscle, or both. A mild residual flexion deformity may be present years after incision and drainage but apparently will cause no functional abnormality.

Abscess↗
PubMed2005

Extension of lumbar spine infection into osteoarthritic hip through psoas abscess.

We present a case of pyogenic lumbar discitis and septic hip arthritis, accompanied by a psoas abscess and pyogenic iliopsoas bursitis, for which the correct diagnosis was delayed. The patho-mechanism was speculated to be initial hematogenous infection in the lumbar spine that spread along the psoas muscle as a psoas abscess and then extended into the hip joint via the iliopsoas bursa. For an early correct diagnosis, clinicians should be aware that the lumbar spine and hip joint regions communicate through the psoas muscle space and iliopsoas bursa, making it possible for infection to spread.

Bursitis↗
PubMed2002

Psoas abscess presenting with femoro-popliteal vein thrombosis.

Psoas abscess is an uncommon condition with vague clinical presentation. It generally has an insidious onset and before the advent of computed tomography, few cases were reported in the medical literature. We report the case of a middle aged diabetic woman who presented with left leg swelling. Doppler ultrasound revealed thrombosis of the popliteal vein and a collection in the left groin. Computed tomography confirmed the presence of a large left iliopsoas abscess extending to the anterior compartment of the thigh complicated with thrombosis of the superficial femoral and popliteal veins. We suggest that an iliopsoas abscess should be excluded when an immunocompromised patient presents with deep vein thrombosis.

Female↗
PubMed1991

Primary pyogenic psoas abscess presenting with paraparesis and motor paralytic bladder.

A case of primary pyogenic psoas abscess presenting with paraparesis and motor paralytic bladder is presented. Available literature on primary psoas abscess, the rarity of neurological sequelae and the role of imaging techniques in diagnosis are discussed. A mechanism for the bladder and lower extremity involvement is proffered. The importance of clinical recognition and early surgical intervention is stressed.

Abscess↗
PubMed2002

Psoas abscess associated with infected total hip arthroplasty.

A 65-year-old man with a left uncemented total hip arthroplasty performed 11 years previously was admitted with a history of progressive low back pain, left hip pain, and sepsis that had begun 6 months earlier. On physical examination, a gross, fluctuant mass was palpated in the left thigh. A computed tomography (CT) scan revealed a 6.5 x 3 cm left retrofascial psoas abscess communicating with the hip joint. The patient underwent irrigation and débridement of the hip with removal of the components. The psoas abscess was drained through the iliopsoas bursa. A residual psoas abscess was drained percutaneously under CT guidance. Cultures isolated Escherichia coli, and the patient responded to 6 months of ciprofloxacin therapy. After 1 year, the patient had no evidence of infection. Pathways of infection spread, diagnosis, and treatment of a patient with this rare association are discussed with a review of the literature.

Aged↗
PubMed1991

[Psoas abscess in pregnancy: a case report].

Psoas abscess is a very rare complication in pregnancy. It creates difficulties in diagnosis and treatment. In our patient pain, fever, leukocytosis and Magnetic Resonance Imaging led to the diagnosis. It was the first manifestation of Crohn's disease.

Abscess↗
PubMedDate not supplied

Psoas abscess. A rare complication of Crohn's disease.

Psoas abscess complicating Crohn's disease is a rare condition. Fever, abdominal tenderness, limb pain and hip contracture are typical signs but only present in half of the cases. Cultures of the pus mostly grow a mixture of enterobacteria. The diagnosis is made by CT-scan. Medical therapy always results in recurrence of the abscess. Resection of the fistula and the affected bowel segment with end-to-end anastomosis is the therapy of choice. A case report is presented, followed by a review of the literature.

Adult↗
PubMed1983

Differentiation of posterior pararenal space infection from psoas abscess by gallium imaging.

Three of four patients whose cases fit the clinical description of psoas abscess proved on gallium imaging to have infection in the posterior pararenal space sparing the psoas muscle. This space provides a route for spread of infection connecting the spine, the anterior abdominal wall, the scrotum, the anterior thigh, and the gluteal region as demonstrated by the cases presented. Clinical differentiation between posterior pararenal space infection and psoas abscesses is difficult and CT studies may not demonstrate the process when the psoas space is not involved.

Abdomen↗
PubMedDate not supplied

Infected pseudocyst in tropical pancreatitis presenting as psoas abscess.

Infected pseudocyst as a consequence of tropical pancreatitis presenting as psoas abscess is unusual. We report a 40-year-old man who presented with pain in the right lumbar region. CT and MRI of the abdomen revealed pancreatic pseudocysts with abscess formation in the psoas muscle and evidence of chronic calcific pancreatitis. He was managed by percutaneous drainage of the abscess along with antibiotics and other supportive measures.

Adult↗
PubMed2005

Bilateral psoas abscess in a case of granuloma inguinale.

The authors present a case of disseminated granuloma inguinale with bilateral psoas abscesses. Infection with calymmatobacterium granulomatis is usually localized to the genital organs but rarely may be disseminated. A search of the literature revealed that only two cases of psoas abscesses due to calymmatobacterium granulomatis were previously reported

Adult↗