Spinal Tuberculosis Presenting as Abdominal Pain: Rare Presentation of a Common Disease

Detection of Spinal Tuberculosis by F-18 FDG PET/CT as a Cause of Unusual Referred Pain in the Right Upper Quadrant of Abdomen

Tuberculous involvement of the spine (tuberculosis [TB] spine) can cause severe morbidity unless detected and treated early. Apart from the constitutional symptoms, it can present with back pain, kyphosis, gait abnormality, and paraplegia secondary to the bone or spinal cord involvement. There had been instances of TB spine presenting directly as abdominal pain due to psoas abscesses. Herein, we report a very rare clinical manifestation of TB spine as referred pain in the right upper abdominal quadrant due to right epidural phlegmon associated with T7 vertebra, detected by positron emission tomography.

Iliopsoas Abscess (together with Bullet) Resulting from a Firearms Injury

Psoas abscess, which is a rarely encountered infection, is defined as the accumulation of suppurative fluid within the fascia surrounding the psoas and iliac muscles. It is categorised as being primary or secondary. Although there are reports in the literature of secondary psoas abscess from foreign bodies, to the best of our knowledge, this is the first reported case of psoas abscess developing due to a bullet, following a firearms injury. The patient was first seen in the Emergency Department following a firearms injury in the posterolateral lumbar region and as the neurovascular examination was normal, the patient was discharged after 24 hours of observation. One month later, the patient presented again to the polyclinic with a high temperature and back pain. As a result of physical examination and tests, a diagnosis was made of psoas abscess and percutaneous drainage was applied under ultrasonography guidance. The complaints improved but, 10 days later with an increase in pain and indications of infection, open abscess drainage was applied and the bullet was removed. At the 6-month follow-up examination, the patient had no complaints.