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Skeletal system involvement is relatively a common complication of human brucellosis. However, muscular involvement is less frequent, and particularly psoas abscess is always secondary to spondylitis. In this case report, psoas abscess formation in a 70 years old female brucellosis patient complicated with spondylitis on vertebral corpus, has been presented.
INTRODUCTION AND OBJECTIVES: To report to the literature a new case of primary psoas abscess. METHODS: The patient is a 65 years old woman who suffered back and left hip pain for approximately 1 month. A CTA showed a retroperitoneal mass that involved the left Psoas. It was drained 1800 cc of purulent fluid infected by Streptococo pneumoniae. RESULTS: In a CTA made 21 days after drainage, showed a very small residual collection. CONCLUSIONS: Primary Psoas Abscess are a very rare entity, with a low rate of mortatility if well treated.
Two cases of staphylococcol psoas abscess are reported. These occurred many years after operations on lumbar discs, complicated by post-operative disc space infection. Clinical and radiological findings are reported. The features of psoas abscess and the management are discussed.
A case of abdominal aortic aneurysm infected by Salmonella dublin is presented. Computed tomography (CT) revealed an abdominal aortic rupture associated with a psoas abscess. An axillo-femoral bypass was performed. The aneurysm and the psoas abscess were resected.
Four patients with Crohn's disease complicated by psoas abscess are described. These patients did not have general or abdominal signs of sepsis but they all showed wasting of the right quadriceps femoris and hip flexion. It is important to examine the hip and thigh in patients with known Crohn's disease who are on medical treatment. Surgical treatment of a Crohn's psoas abscess should include resection of recurrent disease, fashioning of the anastomosis remote from the abscess cavity, and long-term (21 days) drainage of the abscess cavity to avoid the possibilities of faecal fistula or recurrent abscess.
From 1976 to 1984, 43 patients with psoas abscess were seen at the Mayo Clinic. Intestinal disease, including Crohn's disease, diverticulitis, and carcinoma, was the most frequent cause (14 patients). Eleven patients had osteomyelitis, five had postoperative complications, four had a foreign-body reaction, and three had a primary staphylococcal abscess. Two patients each had extension of a primary pancreatic and perinephric abscess. One patient had tuberculosis of the spine, and in the remaining patient, an exact cause was not determined. Definitive treatment of psoas abscess includes adequate debridement, drainage of the abscess cavity, and resection of involved bowel.
We report a case of primary psoas abscess with paravesical extension. A 16-year-old man who had suffered from remittent fever for two months was admitted to our clinic. He had no urological symptoms or walking disturbances, but ultrasonography showed a well-defined echoic mass at the right paravesical space. Computed tomography confirmed this finding, and right psoas muscle appeared to be enlarged with irregular low density areas. Percutaneous drainage for right paravesical abscess was performed, and 15 ml of pus was obtained. The bacterial and fungal culture of the specimen resulted in no growth of any organisms. Six days after percutaneous drainage, he received en bloc resection of right paravesical abscess with segmental resection of bladder wall and peritoneum adherent to it. Furthermore, the affected region of the right psoas muscle was salvaged as highly upward as possible. Surgical specimen disclosed, pathologically, a non-specific granuloma with stellate necrosis. This finding suggested a feature of cat-scratch disease, tularemia, lymphogranuloma venereum and Yersinia infection. We reviewed the related literature on diagnostic images such as CT, ultrasonography and 67Ga scintigraphy. Moreover, bacterial causes and therapy of primary psoas abscess are discussed.
We report a rare case of dual infection in a psoas abscess. Pus from the abscess grew Salmonella typhi and the abscess wall showed epitheloid granulomas giant cells, which we confirmed as tuberculosis by PCR. Such dual infection cases may be missed unless looked for since both these infections are common in our country.
Crohn's disease primarily affects the distal gastrointestinal tract, yet it is a systemic disease that can involve nearly any organ. A psoas abscess complicating Crohn's disease is uncommon and usually originates from a fistulous communication with an adherent bowel. Spinal epidural abscess, an extremely rare complication, also appears to arise by fistulization from another organ involved with Crohn's disease. Previous reports indicate that abscesses in these two areas usually contain bacterial organisms, often mixed flora, consistent with seeding from a diseased bowel. This report represents the first case of Crohn's disease complicated by both bilateral sterile psoas abscesses and a coexistent sterile epidural abscess without evidence of a fistulous communication from the bowel. We report this case because psoas and epidural abscesses can present without typical signs and symptoms. Once suspected, aggressive diagnostic workup and definitive operative intervention is indicated. Failure to promptly diagnose and treat these abscesses may result in considerable morbidity.
In a retrospective study, 24 patients treated at King Edward VIII Hospital from 1985 to 1988 for acute pyogenic psoas abscess were reviewed. The main initial complaints were a painful hip and difficulty in walking. Twenty-two patients had a fixed flexion deformity of the ipsilateral hip. Ultrasonography used as a screening method elucidated the clinical diagnosis in 19 patients. Twenty-two children required incision and drainage, and Staphylococcus aureus was isolated in 20 patients either on blood culture or pus swab. Although the condition is common in the tropics, an acute pyogenic psoas abscess should always be considered in the differential diagnosis of pain in the hip region.
We describe a 69-year-old male patient on maintenance hemodialysis for 24 years who developed a fatal left psoas abscess with osteomyelitis at the hip joint following acute enterocolitis. He had systemic beta(2)-microglobulin amyloid deposition in colon epithelium and psoas muscle. Cultures from abscess fluid and femoral bone marrow yielded Bacteroides fragilis. To our knowledge, this is the first case on hemodialysis having a psoas abscess following acute gastrointestinal infection. This rare case suggested that a secondary psoas abscess could be one of the occult infections in patients undergoing long-term maintenance hemodialysis.
We report herein the cases of two patients with Crohn's disease complicated by a psoas abscess. The first patient was a 29-year-old man who underwent definitive surgery after acute inflammation had been controlled by nutritional therapy. In the second patient, a 37-year-old man, the abscess required drainage under local anesthesia prior to surgery. Both patients have been free from recurrence of any abdominal symptoms for about 2 years since undergoing surgery. Although psoas abscess is still regarded as a rare complication, with the increasing prevalence of Crohn's disease in Japan it has become one of the most important complications requiring surgical intervention.
The triad of fever, limp, and pain in the flank, pelvis or leg often leads to the evaluation of the hip, genitourinary or gastrointestinal system. In the past 6 years, at our hospital, five adolescents and one young adult with these symptoms have had an ilio-psoas abscess, all diagnosed by ultrasonography. Once the diagnosis was established, four patients were treated successfully by percutaneous retroperitoneal drainage guided by ultrasonography or computed tomography. Catheter drainage averaged 11 days accompanied by appropriate antibiotics. The remaining two patients had surgical transperitoneal drainage. Growth of Staphylococcus aureus, from an ilio-psoas abscess indicates that the process is primary in origin. Growth of fecal flora suggests an intra-abdominal process and warrants further investigation. Ilio-psoas abscess can be readily diagnosed by ultrasonography or computed tomography and treated by percutaneous retroperitoneal drainage.
Psoas muscle abscess is an uncommon and challenging entity. The present report describes a 64-year-old man presenting with right flank mass. Abdominal computerized tomography showed a right psoas abscess. Extraperitoneal drainage was performed, and pathology revealed metastatic mucinous adenocarcinoma. After further study, laparotomy and right hemicolectomy were performed under the impression of colon cancer. The final pathology showed mucinous cystadenocarcinoma of appendix. The literature about the etiology, diagnosis and treatment of psoas abscess are reviewed. Additionally, the treatment and prognosis for mucinous cystadenocarcinoma of the appendix are noted.
The case of an 81-year-old ex-smoker male diagnosed with chronic bronchitis and undergoing treatment for pulmonary tuberculosis who presented a left iliac psoas abscess of torpid evolution is herewith reported. The detection of aerobic, anaerobic, fungal and mycobacterial microorganisms was repeatedly negative and was finally found to be an abscessed metastasis of epidermoid lung cancer. The aspects related to psoas abscess, muscular metastasis of bronchogenic carcinoma and the association between tuberculosis and lung cancer are discussed.
A 47-year-old man was admitted with septic fever over a few days. A CT-scan showed a psoas abscess, which was drained by surgery. In the meantime antibiotics were started. In spite of this treatment, he continued to have septic fever. Bone scintigraphy and MR-scan showed activity in the right sacroiliac joint compatible with sacroiliitis. The joint was opened surgically and revised. The patient was treated with antibiotics for nine weeks and was fully restituted. It must be concluded that the psoas abscess was secondary to the sacroiliitis, a rare event.
This case is presented to emphasize that late infection should be considered in all postoperative patients as a cause of pain. A psoas abscess may remain dormant for many years after an anterior spinal procedure. It should be considered in the differential diagnosis of back pain and lumbar radiculopathy after anterior spinal fusion. The lumbar nerve plexus lies within the psoas muscle, and referred pain patterns may occur in the lumbar nerve distribution. In this case, dysesthesias occurred in the distribution of the genitofemoral nerve. The diagnosis and treatment of a psoas abscess has been greatly aided by use of CT and ultrasound. Either of these modalities may be used for directed percutaneous drainage of the abscess. The presence of metal fixation devices necessitates removal of the hardware in order to ensure eradication of the infection.
We report an unusually uncommon case of genitourinary rhabdomyosarcoma in a child which was chemoresistant and complicated by a primary psoas abscess which presented as a pelvic mass associated with an abscess of the right iliac fossa. Ultrasound and CT investigations suggested the diagnosis of a centropelvic tumor which was confirmed at puncture-aspiration. MRI was most contributive giving a precise description of the local extension. Intensive multi-drug chemotherapy would appear to have improved outcome in patients with poor-prognosis Maurer group III tumors. In exceptional cases when no tumor response is obtained, carcinological surgery with large dissection, possibly with adjuvant radiotherapy, is indicated. Percutaneous drainage of the deep psoas abscess is as effective as classical surgery and spares the abdominal wall, particularly important if a second operation should be needed. Multidisciplinary management is required for the treatment of this highly malignant tumor.