[Bilateral brucellosic psoas abscess: one case is related and literature review]

The Brucellosis is a zoonotic and unfrequent infection but it is endemic in Spain. It is a well documented cause of fever of unknown origin with varied and nonspecific symptoms. The onset of symptoms of brucellosis may be abrupt or insidious, developing over several days to weeks. Virtually any organ system can be involved with brucellosis and localization of the process may cause focal symptoms. The most frequent focal presentation is the osteoarthicular. Some times it can complicates with para-perivertebral abscess. The unilateral psoas abscess(PA) is uncommon and the bilateral afection is exceptional. The manifestations of PA usually are insidious, the classic tiad of: feber, lumbar pain and functional impotence is rare. For the diagnosis the serology c tests and cultures are necesary. The imaging techniques like: Ultrasonography and Tomography have improved the diagnosis and treatment of this pathologies' complications. The recommended therapy is the use of doxycicline and streptomicine. Some times the use of percutaneous drainage or open surgery is necessary.

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.

Successful treatment of a ruptured infected aneurysm of the lumbar artery with transcatheter embolization

We report a patient who had an infected aneurysm of the lumbar artery caused by prolonged psoas abscess-forming spondylitis due to methicillin-resistant Staphylococcus aureus and who was treated successfully with transcatheter arterial embolization. This case suggests that an infected aneurysm can be treated successfully by transcatheter arterial embolization in emergent situations (active bleeding or septicemia) even if surgery is contraindicated.

[Videoendosurgical treatment of postinjection abscesses and phlegmons]

Method of treatment of postinjection abscesses and phlegmons was developed. This method includes endovideoscopy of purulent focus with creation of permanent liquid medium, visual revision of purulent cavity with evacuation of pus, controlled radical surgical treatment and introduction of perforated drainages for flowing drainage. Hand endoscopic instruments or special shaver were used for surgical necrectomy. Flowing-aspiration drainage of formed cavity was performed after surgery. This technique was used in 12 patients. It permitted to improve significantly results of treatment, reduce period of temporary disability and achieve good cosmetic effect.

Retroperitoneoscopic drainage of a psoas abscess

Pyogenic psoas abscess in the pediatric age group is a primary condition caused mostly by Staphylococcus aureus. The preferred treatment is percutaneous or surgical drainage under a cover of systemic antibiotics. Laparoscopic drainage scores over open surgery in terms of minimal invasion, shorter hospital stay, better patient comfort, and more complete drainage compared with the percutaneous approach. The authors report a case of a 4-year-old boy with a psoas abscess that was effectively drained laparoscopically through an extraperitoneal approach.

Percutaneous drainage of large tuberculous iliopsoas abscess via a subinguinal approach: a report of two cases

Two patients who had large tuberculous abscesses that were successfully treated with percutaneous drainage alone are reported. A new approach, called the "subinguinal approach," was used. This new technique avoids the bowel loops and pelvic organs (which can be limitations when using the anterior abdominal approach) by inserting the catheter through the subinguinal portion of the psoas muscle into the abscess. Compared to the posterior approach, this technique is more comfortable for the patient (who prefers a supine position) and is not limited by the iliac bone. The technique, clinical course, and outcome are described.

[Pyogenic sacroiliitis complicated by iliopsoas muscle abscess]

Both pyogenic sacroiliitis and iliopsoas muscle abscess are uncommon infectious entities, and their coexinstence has been reported in very few patients. We present here the case of a woman who developed a large iliopsoas abscess as a consequence of a pyogenic sacroiliitis, initially misdiagnosed as a common sciatica and treated with corticosteroids. The patient was cured by the surgical drainage of the abscess and a long-lasting antibiotic treatment. We discuss diagnostic difficulties linked to the two infectious entities, their possible pathogenic connections, the role of imaging procedures, and therapeutic options. We conclude that pyogenic sacroiliitis and the potential evolution to an iliopsoas abscess must be taken into consideration in the differential diagnosis of lower back pain, especially if fever is a concomitant sign.

Computed tomography-guided percutaneous catheter drainage of primary and secondary iliopsoas abscesses

AIM

To report our experience with computed tomography (CT)-guided percutaneous catheter drainage (PCD) of iliopsoas abscesses.

MATERIALS AND METHODS

Twenty-two iliopsoas abscesses in 21 patients (11 women, 10 men) aged between 18 and 66 years (mean 36 years) were treated with PCD. Abdominal CT demonstrated the iliopsoas abscesses, which were definitively determined by Gram staining and aspirate cultures. Twenty of the 22 iliopsoas abscesses were primary and two were secondary. All PCD procedures were performed under local anaesthesia using a single-step trocar technique (n=19) or Seldinger technique (n=3).

RESULTS

PCD was an effective treatment in 21 out of the 22 iliopsoas abscesses. Recurrence was seen in three abscesses as minimal residual collections. Two of them resolved spontaneously with anti-tuberculous regimen. One required percutaneous needle aspiration. The procedure failed in a diabetic patient with a secondary abscess, who died due to sepsis. The length of time that catheters remained in place ranged from 21 to 75 days (mean 59.7 days). Complications included catheter dislocation in four abscesses, which required removal of dislocated catheters and indwelling new ones.

CONCLUSION

CT-guided PCD is a safe and effective front-line treatment of iliopsoas abscesses. Surgery should be reserved for failure of PCD and presence of contraindications to PCD.

Acute pyogenic sacroiliitis without predisposing conditions

STUDY DESIGN

Clinical and imaging findings of patients diagnosed with pyogenic sacroiliitis were retrospectively analyzed.

OBJECTIVES

To characterize the clinical and magnetic resonance features of patients with acute pyogenic sacroiliitis without the usually known predisposing conditions and to investigate the diagnostic value of magnetic resonance imaging in detecting the early stages of pyogenic sacroiliitis.

SUMMARY OF BACKGROUND DATA

Pyogenic sacroiliitis is relatively uncommon, and accurate diagnosis is frequently delayed due to lack of awareness by clinicians and nonspecific clinical presentation. There have been few reports that have evaluated the clinical features of acute pyogenic sacroiliitis and investigated the diagnostic capabilities of magnetic resonance imaging in detecting pyogenic sacroiliitis in the early stages.

METHODS

The clinical data of 9 patients (6 male, 3 female; average age 27.3 years) diagnosed with acute pyogenic infection of the sacroiliac joint were retrospectively analyzed. Magnetic resonance images as well as computed tomography of the sacroiliac joints were available in all cases. Seven of the patients underwent 99mtechnetium bone scans.

RESULTS

All patients showed positive findings on magnetic resonance images, whereas 99mtechnetium bone scans were positive in six of seven patients. Eight patients responded well to treatment with intravenous antibiotic therapy, whereas one patient required debridement of the sacroiliac joint following conservative treatment.

CONCLUSIONS

Both magnetic resonance imaging and technetium bone scanning are sensitive for localizing occult sites of bone inflammation. Magnetic resonance imaging may provide more useful information than bone scanning by screening for abnormalities in the sacroiliac joint region. With prompt appropriate antibiotic therapy, clinical improvement of patients can be expected.

Is spinal instrumentation a risk factor for late-onset infection in cases of distant infection or surgery? Case report

As a cause of revision spinal surgery, spinal epidural abscess after instrumentation-assisted fusion is rare in neurosurgical practice. Postoperative infections are frequently seen in the time period soon after surgery. The authors report on the case of a 45-year-old woman who had undergone posterior instrumentation-augmented fusion for L4-5 degenerative spondylolisthesis. Ten months after the operation she presented to the neurosurgery clinic with complaints of severe low-back pain and radicular right lower-extremity pain. She had undergone laparoscopic surgery for acute cholecystitis 1 month prior to readmission. Radiological study revealed a spinal epidural abscess in communication with a right psoas abscess at L4-5. The abscess was drained percutaneously with the aid of C-arm fluoroscopic guidance, and a 6-week course of parenteral antibiotic therapy was administered. Retrograde lymphatic bacterial translocation, hematopoietic spread, and the suitable characteristics in the host may facilitate the development of infection around the implant. Thus, distant surgery and infection may be a risk factor in cases in which spinal instrumentation is placed. In such cases a prolonged antibiotic therapy for distant infection after surgery is recommended.

[28-Year-Old Patient with Elevated Serum IgE Levels and Multiple Refractory Epidural and Paravertebral Abscesses. Clinical manifestation of a Job's Syndrome?]

BACKGROUND

The hyper-IgE syndrome is a rare primary immunodeficiency characterized by recurrent staphylococcal infections and high levels of serum IgE.

CASE REPORT

The case of a 28-year-old man with epidural and paravertebral abscesses and a markedly elevated serum IgE level of 2,609 U/ml is reported. There was no allergic diathesis, nor had the patient a history of other diseases, which might explain the high serum IgE level. In a blood culture, Staphylococcus aureus was detected. Since early childhood, the patient has suffered from recurrent skin infections.

CONCLUSION

The presented study case discusses the diagnosis of a Job's syndrome in this patient and reviews previously published cases. It also summarizes the current knowledge about pathogenesis and diagnostic criteria of this rare syndrome.

[Psoas abscesses. Genesis, diagnosis, and therapy]

BACKGROUND

A psoas abscess is a rarely encountered entity with various etiologies and nonspecific clinical presentation, frequently resulting in delayed diagnosis, increased morbidity, and prolonged or recurrent hospitalization.

PATIENTS AND METHODS

Between January 1996 and January 2002 we treated ten patients (approximately 54.8, 5 males,5 females). These cases were analyzed retrospectively relative to a review of the literature.

RESULTS

CT scanning was decisive in the final diagnosis of psoas abscess. Primary psoas abscess occurred in four cases and six patients had secondary abscesses. In all except one case, the psoas abscess was located on the right side. The causes of primary abscesses were retroperitoneal perforated appendicitis, paravertebral injections for lumboischialgia, Pott's disease, and repeated intravenous drug application in the groin. Five patients underwent retroperitoneal open drainage and four patients CT-guided drainage. One patient with retroperitoneal perforated appendicitis was treated by laparotomy. Staphylococcus aureus, Bacteroides fragilis, and Escherichia coli were the most common infective agents. There was no postoperative mortality and no cases of abscess recurred.

CONCLUSIONS

CT scan is a diagnostic "gold standard" for psoas abscess. CT-guided drainage is the method of first choice, but is not possible in all cases. Open retroperitoneal drainage is a standard method of treatment. Postoperative antibiotic therapy is obligatory and should be adapted individually.

[Psoas abscess after anterior spinal fusion]

We present 3 cases of secondary psoas abscess after anterior spinal fusion. Psoas abscess is still a rare clinical entity. It is often associated with unspecific symptomatology and may present as late infection. A high index of suspicion is required for early diagnosis and treatment. Computed tomography is the imaging technology of choice. Treatment includes open abscess drainage and antibiotic therapy. In secondary psoas abscess causative treatment of the primary infection focus is essential. For psoas abscess after anterior spondylodesis this includes treatment of a deep wound infection. Predisposing factors for postoperative infection are large implants, bone grafting, long operating times, previous spinal surgery, immunodeficiency and metabolic disorders. Usually several operations are necessary to eradicate infection. As long as stability is guaranteed, implant materials should be removed. Continuing antibiotic therapy for 2-3 weeks after normalization of infectious parameters is suggested. Delayed therapy results in an increase of the morbidity and mortality of psoas abscess.

[Mycotic aneurysm of the subrenal abdominal aorta: extra anatomical reconstruction in five patients]

Between 1988 and 2001, five patients with mycotic aneurysm of the abdominal aorta underwent surgery. Extra-anatomical reconstruction with axillo-bifemoral bypass grafting was performed in all patients. The hospital mortality rate was 20%. During the follow-up period two patients presented thrombosis of the axillo-bifemoral bypass, descending aorto-bifemoral bypass was performed in one. Extra-anatomic revascularization is a satisfactory procedure in the treatment of mycotic abdominal aortic aneurysm. The results are acceptable and the prognosis is mainly related to the underlying pathology and the severity of the infection.

A non-infective cause of recurrent purulent arthritis

We describe a case of recurrent attacks of acute sterile pyogenic arthritis in a 66-year old man. Seven years after the first presentation the diagnosis of acute disseminated fatty necrosis (DFN) was made.

[Inflammatory pseudotumor of the ileopsoas muscle with femoral paralysis caused by massive metal abrasion of a hip endoprosthesis]

Case report of a 62-year-old patient with a presumed loosening of a hip endoprosthesis after 10 years and a planned replacement. In addition, the patient suffered pain in the thigh and had paresis of the femoral nerve. A CAT-Scan substantiated the diagnosis either of a suppurating or a neoplastic tumour in the left iliac foss. The wide excision revealed a rare inflammatory tumour in the left ileopsoas muscle due to the excessive abrasion of the metal hip endoprosthesis.

Image-guided percutaneous drainage of tuberculous iliopsoas and spondylodiskitic abscesses: midterm results

PURPOSE

To evaluate midterm results of percutaneous drainage (PD) with image guidance in 21 patients with tuberculous iliopsoas abscesses with or without spondylodiskitis.

MATERIALS AND METHODS

Computed tomography (CT)-guided PD was performed in 21 patients with 26 tuberculous iliopsoas abscesses. Nineteen patients had bone involvement of two or more vertebrae. Eleven patients with spondylodiskitis had intradiskal abscesses. Five patients had bilateral psoas abscesses. Easily and safely accessible well-circumscribed abscesses larger than 3 cm were selected for PD. Catheters were inserted into the abscess cavities with Seldinger technique in all cases. In conjunction with PD, all patients had antituberculous drug therapy and underwent clinical and imaging follow-up for at least 1 year.

RESULTS

Percutaneous catheter placement was successful in all cases without procedural complications. On the basis of CT findings, complete evacuation of all abscesses was achieved initially. During follow-up, six (29%) of 21 patients had recurrences within 1 and 3 months after catheter removal. A total of 37 catheters were used; eight of the 37 catheters were inserted due to recurrences. Four patients needed two PD procedures, and two patients needed three due to recurrences. Four catheters were changed because of obstruction or dislocation. Drainage duration ranged from 5 to 36 days (mean, 14.9 days). The follow-up period was 12-52 months (mean, 24 months). None of the patients, including those with recurrence, required surgical drainage and débridement due to insufficient PD.

CONCLUSION

Image-guided PD in conjunction with antituberculous drug therapy is an effective and safe procedure in the treatment of tuberculous iliopsoas abscesses with or without spondylodiskitis.

[Psoas abscess. Etiology and treatment]

Psoas abscess is in general a syndrome with low incidence. In the following, two cases are presented which describe the etiology, diagnosis, and treatment of primary and secondary retroperitoneal manifestations. The article mainly focuses on the different respective surgical procedures. Because of its rareness, an overview of further cases discussed in the literature is provided.

[Psoas abscess: 12 case reports]

Psoas abscess are rare. Primitives or secondary their clinical diagnosis is difficult. Imagery and especially computed tomography is fundamental. Treatment associates antibiotherapy and drainage. This drainage can be percutaneous or surgical (open surgery). The authors analyze in a retrospective way 12 cases of abscess of the psoas.

Primary psoas abscess

Psoas abscess is an uncommon condition with varied etiology. Diagnosis is based on symptoms, signs, and CT scan of the abdomen. Treatment consists of adequate drainage either percutaneously or surgically with antibiotic coverage. Serious complications such as sepsis and mortality may result if there is a delay in treatment.