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Al-Khafaji MQ, Al-Smadi MW, Al-Khafaji MQ, Aslan S, Al-Khafaji YQ, Bagossy-Blás P, Al Nasser MH, Horváth BL, Viola Á. Evaluating Imaging Techniques for Diagnosing and Drainage Guidance of Psoas Muscle Abscess: A Systematic Review. J Clin Med 2024; 13:3199. [PMID: 38892910 PMCID: PMC11173313 DOI: 10.3390/jcm13113199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/03/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Psoas muscle abscess (PMA) is an uncommon yet severe condition characterized by diagnostic and therapeutic challenges due to its varied etiology and nonspecific symptoms. This study aimed to evaluate the effectiveness and accuracy of various imaging techniques used in the image-guided percutaneous drainage (PD) of PMA. Methods: A systematic review was conducted following the PRISMA guidelines. We searched PubMed, Google Scholar, and Science Direct for studies published in English from 1998 onwards that reported on the use of PD in treating PMA, detailing outcomes and complications. Imaging modalities guiding PD were also examined. Results: We identified 1570 articles, selecting 39 for full review. Of these, 23 met the inclusion criteria; 19 were excluded due to unspecified PMA, absence of imaging guidance for PD, or inconclusive results. Eleven studies utilized computed tomography (CT) for PD, with six also using magnetic resonance imaging (MRI). Ten studies implemented ultrasound (US)-guided PD; variations in diagnostic imaging included combinations of US, CT, and MRI. A mixed approach using both CT and US was reported in two articles. Most studies using CT-guided PD showed complete success, while outcomes varied among those using US-guided PD. No studies employed MRI-guided PD. Conclusions: This review supports a multimodal approach for psoas abscess management, using MRI for diagnosis and CT for drainage guidance. We advocate for Cone Beam CT (CBCT)-MRI fusion techniques with navigation systems to enhance treatment precision and outcomes, particularly in complex cases with challenging abscess characteristics.
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Affiliation(s)
- Murtadha Qais Al-Khafaji
- Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (M.Q.A.-K.); (M.Q.A.-K.); (Y.Q.A.-K.)
| | - Mohammad Walid Al-Smadi
- Department of Neurosurgery and Neurotraumatology, Dr. Manninger Jenő National Traumatology Institute, 1081 Budapest, Hungary; (M.W.A.-S.); (S.A.); (P.B.-B.)
| | - Mustafa Qais Al-Khafaji
- Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (M.Q.A.-K.); (M.Q.A.-K.); (Y.Q.A.-K.)
| | - Siran Aslan
- Department of Neurosurgery and Neurotraumatology, Dr. Manninger Jenő National Traumatology Institute, 1081 Budapest, Hungary; (M.W.A.-S.); (S.A.); (P.B.-B.)
- Department of Neurotraumatology, Semmelweis University, 1081 Budapest, Hungary
- Doctoral School of Clinical Medicine, Semmelweis University, 1083 Budapest, Hungary
| | - Yousif Qais Al-Khafaji
- Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (M.Q.A.-K.); (M.Q.A.-K.); (Y.Q.A.-K.)
| | - Panna Bagossy-Blás
- Department of Neurosurgery and Neurotraumatology, Dr. Manninger Jenő National Traumatology Institute, 1081 Budapest, Hungary; (M.W.A.-S.); (S.A.); (P.B.-B.)
| | - Mohammad Hakem Al Nasser
- Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (M.Q.A.-K.); (M.Q.A.-K.); (Y.Q.A.-K.)
| | - Bálint László Horváth
- Department of Traumatology, Dr. Manninger Jenő National Traumatology Institute, 1081 Budapest, Hungary;
| | - Árpád Viola
- Department of Neurosurgery and Neurotraumatology, Dr. Manninger Jenő National Traumatology Institute, 1081 Budapest, Hungary; (M.W.A.-S.); (S.A.); (P.B.-B.)
- Department of Neurotraumatology, Semmelweis University, 1081 Budapest, Hungary
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Jiang K, Zhang W, Fu G, Cui G, Li X, Ren S, Fu T, Geng L. Ultrasound-Guided Percutaneous Drainage of Iliopsoas Abscess With Septicemia in an Adolescent: A Case Report and Literature Review. Front Surg 2022; 9:871292. [PMID: 35832495 PMCID: PMC9271797 DOI: 10.3389/fsurg.2022.871292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionIliopsoas abscess with septicemia in the pediatric population is rare. Early diagnosis and effective management of this emergent disorder remain challenging for clinicians.Case PresentationA 14-year-old girl presented with right lateral and posterior hip pain and fever for 7 days before admission. Blood culture was positive for Staphylococcus aureus. Enhanced magnetic resonance imaging revealed abscesses located in the right iliopsoas muscle and on the surface deep to the fascia of the right sacroiliac joint that were 6.8 cm × 6.2 cm × 5.7 cm and 3.7 cm × 3.5 cm × 2.1 cm, respectively. A diagnosis of right iliopsoas abscesses with septicemia was made. The patient received intravenous antibiotics, underwent ultrasound-guided percutaneous catheter drainage, and recovered uneventfully. Medical literature regarding this issue published in the English language during the last two decades was reviewed.DiscussionPrimary synchronous psoas and iliacus muscle abscesses are rare and emergent disorders in the pediatric age group. The diagnosis is generally delayed owing to the deep anatomic location and nonspecific signs and symptoms. A comprehensive medical history, meticulous physical examination, and judicious use of imaging studies could establish a timely and accurate diagnosis. Surgeons should be aware of the occurrence of multiple abscesses. Prompt and adequate antibiotic therapy accompanied by a mini-invasive approach, such as ultrasound-guided, laparoscopic, or video-retroperitoneoscopic drainage of the infectious focus, if indicated and feasible, is important to achieve a good outcome in the management of iliopsoas abscess.
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Affiliation(s)
- Kun Jiang
- Department of Pediatric Surgery, Binzhou Medical Unversity Hospital, Binzhou, China
| | - Wenxiao Zhang
- Department of Ultrasonic Medicine, Binzhou Medical Unversity Hospital, Binzhou, China
| | - Guoyong Fu
- Department of Pediatric Surgery, Binzhou Medical Unversity Hospital, Binzhou, China
| | - Guanghe Cui
- Department of Ultrasonic Medicine, Binzhou Medical Unversity Hospital, Binzhou, China
| | - Xuna Li
- Department of Pediatric Surgery, Binzhou Medical Unversity Hospital, Binzhou, China
| | - Shousong Ren
- Department of Pediatric Surgery, Binzhou Medical Unversity Hospital, Binzhou, China
| | - Tingliang Fu
- Department of Pediatric Surgery, Binzhou Medical Unversity Hospital, Binzhou, China
- Correspondence: Tingliang Fu Lei Geng
| | - Lei Geng
- Department of Pediatric Surgery, Binzhou Medical Unversity Hospital, Binzhou, China
- Correspondence: Tingliang Fu Lei Geng
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Fesatidou V, Petsatodis E, Kitridis D, Givissis P, Samoladas E. Minimally invasive outpatient management of iliopsoas muscle abscess in complicated spondylodiscitis. World J Orthop 2022; 13:381-387. [PMID: 35582155 PMCID: PMC9048501 DOI: 10.5312/wjo.v13.i4.381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/29/2021] [Accepted: 03/07/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Iliopsoas muscle abscess (IPA) and spondylodiscitis are two clinical conditions often related to atypical presentation and challenging management. They are both frequently related to underlying conditions, such as immunosuppression, and in many cases they are combined. IPA can be primary due to the hematogenous spread of a microorganism to the muscle or secondary from a direct expansion of an inflammatory process, including spondylodiscitis. Computed tomography-guided percutaneous drainage has been established in the current management of this condition.
AIM To present a retrospective analysis of a series of 8 immunocompromised patients suffering from spondylodiscitis complicated with IPA and treated with percutaneous computed tomography-guided drainage and drain insertion in an outpatient setting.
METHODS Patient demographics, clinical presentation, underlying conditions, isolated microorganisms, antibiotic regimes used, abscess size, days until the withdrawal of the catheter, and final treatment outcomes were recorded and analyzed.
RESULTS All patients presented with night back pain and local stiffness with no fever. The laboratory tests revealed elevated inflammatory markers. Radiological findings of spondylodiscitis with unilateral or bilateral IPA were present in all cases. Staphylococcus aureus was isolated in 3 patients and Mycobacterium tuberculosis in 2 patients. Negative cultures were found in the remaining 3 patients. The treatment protocol included percutaneous computed tomography-guided abscess drainage and drain insertion along with a course of targeted or empiric antibiotic therapy. All procedures were done in an outpatient setting with no need for patient hospitalization.
CONCLUSION The minimally invasive outpatient management of IPA is a safe and effective approach with a high success rate and low morbidity.
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Affiliation(s)
- Vasiliki Fesatidou
- 4th Department of General Surgery, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54124, Greece
| | - Evangelos Petsatodis
- Department of Interventional Radiology, Papanikolaou General Hospital of Thessaloniki, Thessaloniki 57010, Greece
| | - Dimitrios Kitridis
- 1st Orthopaedic Department, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54124, Greece
| | - Panagiotis Givissis
- 1st Orthopaedic Department, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54124, Greece
| | - Efthimios Samoladas
- 1st Orthopaedic Department, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54124, Greece
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Ali HM, Shoshan HMA. Multifocal primary musculoskeletal tuberculosis in nonimmunocompromised patient from nonendemic area. BJR Case Rep 2020; 6:20190077. [PMID: 33029366 PMCID: PMC7526995 DOI: 10.1259/bjrcr.20190077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 10/27/2019] [Accepted: 11/22/2019] [Indexed: 11/30/2022] Open
Abstract
Iliopsoas primary tuberculous abscess is a rare clinical and imaging entity. Most reported imaging literature cases are secondary to tuberculous spondylodiscitis. Iliopsoas tuberculous inflammation and abscess constitutes a diagnostic challenge owing to its insidious onset and subtle non-specific symptoms. Here, in a case of right iliopsoas and thigh primary tuberculosis abscess complicated with right iliac bone osteomyelitis extended to the right hip joint. The conventional radiography, thigh and pelvic ultrasonography, MRI and CT examinations showed the whole right iliopsoas and thigh abscess compartments and right iliac bone osteomyelitis. No defined other pulmonary or abdominal tuberculous lesions. Percutaneous drainage of the thigh compartment under ultrasound guidance and microbiologic culture of the drained fluid elicited mycobacterium tuberculosis.
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Ghazanfar H, Ali NN, Cindrich RB, Matela A. A Microbiologist's Mexico Trip Ends with Multiple Tiny Ring-Like Pelvic Abscesses. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e922221. [PMID: 32296009 PMCID: PMC7185817 DOI: 10.12659/ajcr.922221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Patient: Female, 22-year-old Final Diagnosis: Iliacus muscle abscess Symptoms: Back pain • diarhea • leg weakness Medication:— Clinical Procedure: Joint aspiration Specialty: Infectious Diseases • General and Internal Medicine
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Affiliation(s)
- Haider Ghazanfar
- Department of Internal Medicine, BronxCare Health System, Bronx, NY, USA
| | - Nisha N Ali
- Department of Internal Medicine, BronxCare Health System, Bronx, NY, USA
| | - Richard B Cindrich
- Department of Internal Medicine, BronxCare Health System, Bronx, NY, USA.,Division of Infectious Diseases, BronxCare Health System, Bronx, NY, USA
| | - Ajsza Matela
- Department of Internal Medicine, BronxCare Health System, Bronx, NY, USA.,Division of Pulmonary and Critical Care Medicine, BronxCare Health System, Bronx, NY, USA
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Hussain SM, Neilly DW, Baliga S, Patil S, Meek RMD. Knee osteoarthritis: a review of management options. Scott Med J 2016; 61:7-16. [DOI: 10.1177/0036933015619588] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Osteoarthritis of the knee is a complex peripheral joint disorder with multiple risk factors. The molecular basis of osteoarthritis has been generally accepted; however, the exact pathogenesis is still not known. Management of patients with osteoarthritis involves a comprehensive history, thorough physical examination and appropriate radiological investigation. The relative slow progress in the disease allows a stepwise algorithmic approach in treatment. Non-surgical treatment involves patient education, lifestyle modification and the use of orthotic devises. These can be achieved in the community. Surgical options include joint sparing procedures such as arthroscopyando osteotomy or joint-replacing procedures. Joint-replacing procedures can be isolated to a single compartment such as patellofemoral arthroplasty or unicompartmental knee replacement or total knee arthroplasty. The key to a successful long-term outcome is optimal patient selection, preoperative counselling and good surgical technique.
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Affiliation(s)
- SM Hussain
- Consultant Orthopaedic Surgeon, The Queen Elizabeth University Hospital.1345 Govan Road. Govan G51 4TF Glasgow
| | - DW Neilly
- Specialty Registrar, Trauma and Orthopaedics. Aberdeen Royal Infirmary, Foresterhill Rd, Foresterhill, Aberdeen AB25 2ZN
| | - S Baliga
- Clinical Fellow, Department of Orthopaedics and Spinal Surgery, Royal Stoke University Hospital. Newcastle Rd, Stoke-on-Trent ST4 6QG
| | - S Patil
- Consultant Orthopaedic Surgeon, The Queen Elizabeth University Hospital.1345 Govan Road. Govan G51 4TF Glasgow
| | - RMD Meek
- Consultant Orthopaedic Surgeon, The Queen Elizabeth University Hospital.1345 Govan Road. Govan G51 4TF Glasgow
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7
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Minimally invasive retroperitoneoscopic surgery for psoas abscess with thoracolumbar tuberculosis. Surg Endosc 2014; 29:2451-5. [DOI: 10.1007/s00464-014-3913-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 09/08/2014] [Indexed: 10/24/2022]
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8
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Garg B, Chakraborty S, Kumar V, Malhotra R. Massive tubercular pseudo-tumor of the thigh: a case report. Pan Afr Med J 2012; 12:29. [PMID: 22891087 PMCID: PMC3415050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Accepted: 04/09/2012] [Indexed: 10/25/2022] Open
Abstract
Psoas abscess in cases of tuberculosis originates from the primary lesion in the lower dorsal or the lumbar spine. From the spinal origin of the Psoas muscle, this abscess tracks down its sheath and may be palpable in the iliac fossa, in the lumbar triangle, in the upper part of thigh below the inguinal ligament. We present a rare case, where patient presented with thigh swelling, which on first look gave an impression of a malignant origin. But subsequent investigation revealed it to be one of tuberculous origin, and that to, tracking down of a Psoas abscess. According to best of our knowledge, there has been no reported case of a Psoas abscess tracking down to the thigh and knee and mimicking a tumour.
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Affiliation(s)
- Bhavuk Garg
- Department of Orthopaedics, All India Institute of Medical Sciences, India,Corresponding author: Dr. Bhavuk Garg, Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Soumya Chakraborty
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, India
| | - Vijay Kumar
- Department of Orthopaedics, All India Institute of Medical Sciences, India
| | - Rajesh Malhotra
- Department of Orthopaedics, All India Institute of Medical Sciences, India
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9
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Lee JW, Park SK, Kim JY, Park YS, Seo YH, Cho YK. Primary psoas abscess caused by Streptococcus agalactiae. Infect Chemother 2011. [DOI: 10.3947/ic.2011.43.2.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Ji Won Lee
- Department of Internal Medicine, Gachon University of Medicine and Science, Gil Hospital, Incheon, Korea
| | - Sung Keun Park
- Department of Internal Medicine, Gachon University of Medicine and Science, Gil Hospital, Incheon, Korea
| | - Jin Yong Kim
- Department of Internal Medicine, Gachon University of Medicine and Science, Gil Hospital, Incheon, Korea
| | - Yoon Soo Park
- Department of Internal Medicine, Gachon University of Medicine and Science, Gil Hospital, Incheon, Korea
| | - Yiel Hae Seo
- Department of Laboratory Medicine, Gachon University of Medicine and Science, Gil Hospital, Incheon, Korea
| | - Yong Kyun Cho
- Department of Internal Medicine, Gachon University of Medicine and Science, Gil Hospital, Incheon, Korea
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10
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Alvi AR, Rehman ZU, G Nabi ZUR. Pyogenic psoas abscess: case series and literature review. Trop Doct 2010; 40:56-8. [DOI: 10.1258/td.2009.090212] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
From 1998 to 2008, six patients with pyogenic psoas abscesses were managed. Pain and fever were the most common presentations. Two patients had primary pyogenic abscesses and four had secondary pyogenic abscesses. The diagnoses were made either by computed tomography scans (50%) or magnetic resonance imaging and pus culture were obtained. The associated conditions included: perinepheric abscess (1); lumbar discitis (2); and infected thrombosed abdominal aortic aneurysm (1). Five patients underwent radiologically-guided percutaneous drainage and one required open surgical drainage of the abscess cavity. Optimal results were achieved in all cases except one who died of acute myocardial infarction.
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Affiliation(s)
- Abdul Rehman Alvi
- Department of Surgery, Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi – 74800, Pakistan
| | - Zia Ur Rehman
- Department of Surgery, Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi – 74800, Pakistan
| | - Zia Ur Rehman G Nabi
- Department of Surgery, Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi – 74800, Pakistan
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11
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Psoas abscess rarely requires surgical intervention. Am J Surg 2008; 196:223-7. [DOI: 10.1016/j.amjsurg.2007.07.032] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2007] [Revised: 07/10/2007] [Accepted: 07/10/2007] [Indexed: 12/22/2022]
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12
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Plaza R, Soriano A, Tomas X, Gallart X, Garcia S. Psoas abscess associated with infected total hip arthroplasty: a case report. Hip Int 2006; 16:234-7. [PMID: 19219798 DOI: 10.1177/112070000601600310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Psoas abscess (PA) is an uncommon disease and its diagnosis is difficult. It can be primary or secondary. Primary abscesses are of unknown origin and are presumably caused by haematogenous or lymphatic spread from a distant infectious focus. Secondary PA is caused by spreading from a contiguous infected structure, such as vertebrae (espondilodiscitis) or mesenteric abscesses (Crohns disease). PA infrequently has been associated with an infection of total hip arthroplasty (ITHA). The correct diagnosis in these cases is difficult due to the clinical similarities between PA and ITHA. Since connection between PA and ITHA is established through the acetabulum, we consider that computed tomography (CT) is the most accurate radiological test because of its efficacy in evaluating the bone structure, and the optimum therapeutic strategy is two-stage replacement surgery. We report one case of PA associated with ITHA and a review of the previous literature.
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Affiliation(s)
- R Plaza
- Department of Orthopaedics and Trauma Surgery, Barcelona, Spain.
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13
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Kim YO, Woo YJ. Primary psoas abscess confused with hip pathology. KOREAN JOURNAL OF PEDIATRICS 2006. [DOI: 10.3345/kjp.2006.49.5.570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Young Ok Kim
- Department of Pediatrics, Chonnam National University Medical School, Gwangju, Korea
| | - Young Jong Woo
- Department of Pediatrics, Chonnam National University Medical School, Gwangju, Korea
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Abstract
Iliopsoas abscess is a relatively uncommon condition that can present with vague clinical features. Its insidious onset and occult characteristics can cause diagnostic delays, resulting in high mortality and morbidity. The epidemiology, aetiology, clinical features, and management of iliopsoas abscess are discussed.
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Affiliation(s)
- I H Mallick
- University Department of Surgery, Royal Free and University College Medical School, Hampstead, London NW3 2QG, UK.
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15
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Talbot NJ, Costa S, Giles NCL. Pathological hip fracture following intracapsular spread of a psoas abscess. Injury 2004; 35:936-7. [PMID: 15302251 DOI: 10.1016/s0020-1383(02)00371-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2002] [Accepted: 08/15/2002] [Indexed: 02/02/2023]
Affiliation(s)
- N J Talbot
- The Old Dairy, Fore Street, Silverton, Exeter EX5 4HP, UK.
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Sharieff GQ, Lee DM, Anshus JS. A rare case of Salmonella-mediated sacroiliitis, adjacent subperiosteal abscess, and myositis. Pediatr Emerg Care 2003; 19:252-4. [PMID: 12972823 DOI: 10.1097/01.pec.0000086237.54586.92] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We report the case of a 16-year-old female who was ultimately diagnosed with Salmonella sacroiliitis, adjacent subperiosteal abscess, and myositis of the left iliopsoas, gluteus medius, and obturator internus muscles. Early and accurate recognition of this syndrome and other infectious musculoskeletal syndromes can prove difficult for the emergency physician, as these disease processes require special attention to pain of proportion to physical findings and a high index of suspicion.
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Buttaro M, González Della Valle A, Piccaluga F. Psoas abscess associated with infected total hip arthroplasty. J Arthroplasty 2002; 17:230-4. [PMID: 11847626 DOI: 10.1054/arth.2002.28734] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
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.
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Affiliation(s)
- M Buttaro
- Institute of Orthopaedics Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
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Dahami Z, Sarf I, Dakir M, Aboutaieb R, Bennani S, Elmrini M, Benjelloun S. [Treatment of primary pyogenic abscess of the psoas: retrospective study of 18 cases]. ANNALES D'UROLOGIE 2001; 35:329-34. [PMID: 11774765 DOI: 10.1016/s0003-4401(01)00054-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The primitive abcess of psoas muscle is a rare affection which involves mainly the young. The authors report 18 cases of primitive pyogenic abcess of psoas collected during a period of six years in the urology service of UHC Ibn Rochd Casablanca. The purpose of this review is to discuss the different therapeutic attitudes. The study concerned 11 men and seven women, their mean age was 35 years. The mean delay of evolution was 45 days. The physical exam found a psoitisis (five cases) and a flunk swelling (14 cases). The ultrasound exam showed the collection which was hypoechogenic in seven cases and heterogenous in 11 cases. The CT scan showed an heterogenouse hypodense collection without enhansment in seven cases. The use of antibiotherapy alone (four cases) and percutaneous drainage (four cases) permitted the recovery just respectively in one and two cases. Fifteen patients (83%) were operated through a postero-lateral lumbotomy route without costal resection. The bacteriological exam of the pus found a Staphylococcis aureus (ten cases) and Escherichia coli (two cases). The evolution was favorable in 14 cases; one patient was dead at fifth day post operatively by heart infarction. For the authors, the surgical drainage remains the treatment of choice.
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Affiliation(s)
- Z Dahami
- Service d'urologie, CHU Ibn Rochd, Casablanca, Maroc.
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