All presented with fever and elevated white blood cell counts. We wanted to define the role of computed tomography ct in the diagnosis, etiology, and treatment of iliopsoas abscess. Iliopsoas abscess in hemodialysis patients with end. Overview iliopsoas abscess ipa is a rare condition defined by a collection of purulence in the iliopsoas compartment. Iliopsoas abscess is a collection of pus in the iliopsoas muscle compartment.
An iliopsoas abscess ipa can be either primary or secondary. Stretching the iliopsoas is a participatory event that uses your. The classic triad of fever, back pain, and psoas spasm is present in only 30% of patients. This study compared the characteristics of patients with gasforming and nongas forming ipa and their mortality rates. Owing to the proximal attachments of the iliopsoas, such an abscess may drain inferiorly into the upper medial thigh and present as a swelling in the region. Mean age and dialysis vintage at onset were 72 years and 109 months, respectively. Left superior lumbar hernia is an incidental finding in this patient it is often necessary for psoas abscesses to be drained and they are usually amenable to ct guided percutaneous drainage, with the patient in the prone position. Abdominal aortic aneurysmal and endovascular device.
We examined nine hd patients with iliopsoas abscess six men and five diabetes mellitus cases treated between 2005 and 2015. The iliopsoas anatomic area is located in the abdominal retroperitoneal space, and the iliopsoas compartment is seldom affected by pathologic processes. The tendinous portion extends below the inguinal ligament to attach to the lesser trochanter of the. To view other topics, please sign in or purchase a subscription. Delay in diagnosis may occur because of its relative infrequency and often the nonspecific signs and symptoms. Septic emboli affecting many bodily sites have been reported, including the lungs, joints, bones, and brain. The incidence is rare, but the frequency of this diagnosis has increased with the use of computed tomography, prior to which most cases were. Sacral trauma occurred 3 weeks before presentation, with progressive worsening of buttock pain.
Neonatal iliopsoas abscess horiuchi 2012 pediatrics. Iliopsoas abscess is an uncommon phenomenon with an incidence of 0. Ultrasonography and computed tomography ctguided percutaneous drainage associated with systemic antibiotics has been. Primary iliopsoas abscess occurs as a result of hematogenous or lymphatic seeding from a distant site.
Its insidious onset and occult characteristics can cause diagnostic delays. Review iliopsoas abscesses groin pain nontraumatic. The abscess is surrounded by a zone of inflammation. Iliopsoas abscess as the first clinical manifestation of. The manifestations of abscesses depend on their location, depth, and stage of development. Bilateral psoas abscess in the emergency department. Psoas abscess was first described by mynter in 1881 who referred to this condition as psoitis. Iliopsoas abscess cleveland clinic journal of medicine. Iliopsoas abscess is a relatively uncommon condition that can present with vague clinical features. In this stretch the upper front of the left thigh is being stretched gently, slowly and carefully. There are two mechanisms that can lead to the formation of iliopsoas abscess. Patients with inflammatory bowel disease are likely to.
The volume of pus in the cavity of an abscess may reach several liters. Recent advances in the radiological diagnosis of this traditionally rare abscess have highlighted that there is a lack of evidence relating to its aetiology, symptomology, investigation and management. However, there is currently no consensus on when to use pcd or surgical intervention, especially in patients with gasforming ipa. Iliopsoas abscess caused by chronic urolithiasis and.
On day 22 after birth, his family noticed that his right thigh was swollen. The epidemiology, aetiology, clinical features, and management of iliopsoas abscess are discussed. Iliopsoas abscess ipa is a relatively rare but potentially lifethreatening disease. Iliopsoas abscesses are rare infections that pose a. Management and treatment of iliopsoas abscess article in archives of surgery chicago, ill 1960 14410. Pt slowly presses fingers into abdomen approximately one third the distance from the asis toward the umbilicus. Iliopsoas stretches there are many ways to stretch the iliopsoas and here are a few that should only be attempted carefully and if they feel both safe and comfortable to try.
Psoas or iliopsoas abscess is a collection of pus in the iliopsoas muscle compartment 1. Gastrointestinal tract disease is the most common cause, with computed tomography as the diagnostic modality of choice. Seven of eight were successfully drained and surgery avoided. Features and treatment modality of iliopsoas abscess and. The organisms defense reaction is manifested in the formation of a capsule separating the abscess from healthy tissue. Primary iliopsoas abscess has higher incidence in patients with diabetes mellitus, renal failure, immunosuppression and. Findings are in keeping with left psoas muscle abscess. Iliopsoas abscess ipa is rare in children, particularly in neonates. Abdominal computed tomography revealed the presence of a lowdensity mass in the right. Review iliopsoas abscesses postgraduate medical journal. Percutaneous drainage pcd and surgical intervention are two primary treatment options for iliopsoas abscess ipa. Abdominal computed tomography revealed the presence of a lowdensity mass in the right iliopsoas muscle indicative of a psoas.
The difficulty walking is due to the psoas muscle being innervated by l2, l3, and l4 and when these get inflamed the individual experiences pain in the thigh and hip making it tough for. The symptoms of psoas muscle abscess are rather nonspecific. Bacteremia with an iliopsoas abscess and osteomyelitis of the femoral head caused by enterococcus avium in a patient with endstage kidney disease. A patient who presents with pain in the flank, hip, or abdomen may have a primary iliopsoas abscess. Iliopsoas abscess definition of iliopsoas abscess by. First clinical description of eggerthia catenaformis bacteremia in a patient with dental abscess. L, ilium a collection of pus in the iliopsoas muscle, possibly tuberculous in origin, that spreads from the thoracic or lumbar spine to the upper leg muscles, usually caused by staphylococcus infection. A man aged 45 years, with a history of recurrent urolithiasis and pyelonephritis, presented with a 3month history of fever. Iliopsoas abscess article about iliopsoas abscess by the. Eight cases of iliopsoas abscess were diagnosed and treated by computed tomographic ctguided needle aspiration and percutaneous catheter drainage. Iliopsoas abscess presenting with sacral fracture and. A positive sign for an iliopsoas abscess is reproducing or causing lower quadrant, pelvic, or abdominal pain. Individuals with psoas muscle abscess may complain of fever, flank pain, pain in the abdomen, and difficulty walking.
The etiology varied but was definitely established in only four of eight cases. Parvimonas micra, a grampositive anaerobic coccus, is a rare pathogen for psoas abscess. Staphylococcus aureus is the most commonly causative pathogen in primary psoas abscess. Abscess, psoas is a sample topic from the 5minute clinical consult. Patient presents with recurrence of left iliac mass two months after treatment of iliopsoas abscess. It may be necessary to ask the patient to initiate slight hip flexion to help isolate the muscle and avoid palpating the bowel. A case report of an atypical presentation of pyogenic. An easily overlooked presentation of malignant psoas.
Lemierres disease is characterized by sepsis, often with an oropharyngeal source, secondary septic emboli and internal jugular vein thrombosis lancet 1. Ct with contrast showed a right iliopsoas abscess that extended to the inguinal area and a right urethral stone figure 1. Computed tomography is the standard method of diagnosis. This is commonly associated with a chronic immunocompromised state and tends to occur in children and young adults. Ipa is classified as primary when a causative organism from a distant occult site spreads to the iliopsoas compartment by a hematogenous or lymphatic route, or secondary when a contiguous extension of an intraabdominal infectious or. The other causative organisms include proteus,9 pasteurella multocida,14. We describe a case of a patient with iliopsoas abscess caused by p. It may arise via contiguous spread from adjacent structures or by the hematogenous route from a distant site.
Management and treatment of iliopsoas abscess request pdf. Psoas abscess is encountered infrequently in children. Iliopsoas abscess was diagnosed in 61 patients 32 men and 29 women during the study period august 1, 2000, to december 30, 2007. The sheath of the muscle arises from the lumbar vertebrae and the intervertebral discs between the vertebrae. Iliopsoas abscess yu li, hiraku funakoshi, takashi shiga, shigeki fujitani cleveland clinic journal of medicine nov 2017, 84 11 833834. An 81yearold asian man presented to our department with complaints of fever since the preceding day. An abscess in the psoas muscle of the abdomen may be caused by lumbar tuberculosis. Followup mri revealed a communicating iliopsoas abscess that initially had been undiagnosed.
Pdf iliopsoas abscess is a relatively uncommon condition that can present with vague clinical features. Iliopsoas abscess ipa is an uncommon diagnosis in medical wards. The mean age of the patients was 53 years age range, 1495 years. Secondary ipas are often caused by localized infections such as spinal lesions eg, spondylitis and spinal tuberculosis, pancreatitis, urinary tract infections and stones eg, within the kidneys or ureters, appendicitis, and intestinal infections mainly crohn disease.
Iliopsoas abscess ipa is a rare condition with a reported incidence of 0. Percutaneous drainage remains the initial treatment modality but is rarely the sole therapy required. On occasion, ultrasoundguided percutaneous abscess drainage is also. Symptoms are often nonspecific, which makes it difficult to make the diagnosis at the initial visit. Psoas abscess is a rare infectious disease with nonspecific clinical presentation that frequently causes a diagnostic difficulty. Iliopsoas abscess is a rare complication of fistulizing crohns disease, which is difficult to diagnose and manage. Physical examination revealed a nodule in his right inguinal area. Abdominal computed tomography showed a mass extending to the right iliopsoas from the right thigh with thick septa. We report this case to alert clinicians to the diagnosis and management of this unusual association. Its insidious onset and occult characteristics can cause diagnostic delays, resulting in high mortality and morbidity. Primary iliopsoas abscess combined with rapid development. Iliopsoas abscess is a condition rarely encountered in the modern age.