Absceso piógeno en psoas como causa de deterioro funcional subagudo en el paciente anciano. A propósito de un caso / Pyogenic psoas abscess as a cause of subacute functional impairment in the elderly patient

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Sacroilitis séptica y absceso en el psoas / Septic sacroilitis and psoas abscess

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Absceso de psoas: una aproximación a la cojera aguda de origen infeccioso / Psoas abscess: an approach to acute limp of infectious origin in children

La cojera aguda en el niño es un motivo de consulta frecuente que ofrece un diagnóstico diferencial muy amplio. Algunas de sus posibles causas implican patologías con necesidad de tratamiento urgente y no todas ellas se sospechan de forma rutinaria. Presentamos el caso de un niño de siete años de edad que consultó por cojera, fiebre, dolor abdominal y afectación del estado general. Se descartaron artritis séptica de la cadera y osteomielitis femoral. Fue ingresado en el hospital con antibioterapia de amplio espectro con buena evolución. Se realizó una resonancia magnética que demostró un absceso de psoas junto con una osteomielitis del cuerpo vertebral L4 (AU)

Acute gait abnormalities offer a wide range of diagnosis. Some of those conditions are life-threatening and usually not suspected, such as the psoas abscess (PA). We report a seven year-old child presented to the Emergency Department with limp, fever and abdominal pain. Septic arthritis of the hip and femoral osteomyelitis were ruled out. He was admitted to hospital and put on broad-spectrum antibiotics with good response. A magnetic resonance imaging showed a psoas abscess together with an osteomyelitis of the L4 vertebral body (AU)

Dolor lumbar persistente debido a absceso del psoas ilíaco / Persistent back pain due to an iliopsoas abscess

Paciente de 14 años sin antecedentes de interés que comienza de forma espontánea con dolor lumbar, que no mejora con tratamiento habitual (reposo, calor y antiiflamatorios no esteroideos), con empeoramiento progresivo del dolor, obligándole a consultar por el mismo motivo en cuatro ocasiones en diferentes centros médicos. Finalmente es diagnosticado, con la ayuda de la tomografía computarizada lumbar, de absceso del psoas ilíaco, probablemente secundario a sacroileítis, con el consiguiente ingreso para tratamiento antibiótico. El paciente de nuestro caso presenta buena evolución, con buena respuesta a la antibioterapia, sin complicaciones ni secuelas importantes, y sin ser necesario el drenaje quirúrgico de la colección (AU)

We present a 14 years old patient with unremarkable medical history, that begins spontaneously with low back pain that does not improve with standard treatment (rest, heat and non-steroidal anti-inflammatory drugs), with progressive worsening of pain, for which he consults four times in different medical centres. The final diagnosis is an iliopsoas abscess, seen on a lumbar Computerized Tomography, and he is consequently admitted to hospital to receive intravenous antibiotics. The patient in our case has a good response to treatment, without any complications or serious squeals, and without requiring a surgical drainage of the collection (AU)

Absceso epidural y de psoas bilateral tras anestesia epidural obstétrica: una complicación poco frecuente / Epidural and bilateral psoas abscess after obstetric epidural anaesthesia: a rare complication

El absceso epidural espinal tras anestesia epidural es una complicación rara. Se describe un caso de absceso epidural y de psoas tras anestesia epidural para un parto sin complicaciones. Su diagnóstico requiere un alto índice de sospecha clínica y un estudio de resonancia magnética. La descompresión quirúrgica precoz y antibioterapia prolongada son los elementos clave en el tratamiento del absceso epidural, mientras el absceso de psoas precisa drenaje percutáneo con control radiológico y cobertura antibiótica. El absceso epidural tras anestesia epidural puede suponer una complicación catastrófica. Un diagnóstico precoz es esencial para prevenir daños neurológicos permanentes (AU)

Epidural abscess is a rare but serious complication of epidural anesthesia. We present the case of a healthy parturient who developed spinal epidural and psoas muscle abscesses following spinal analgesia for uneventful labor and delivery. Diagnosis requires a high index of suspicion and magnetic resonance imaging. Early surgical decompression and prolonged antibiotic therapy are the mainstays of epidural abscess treatment, while percutaneous drainage under imaging guidance with antibiotic coverage is an effective front-line treatment of psoas muscle abscess. Epidural abscess can be a catastrophic consequence of epidural anesthesia. Early diagnosis is essential to prevent permanent neurological damage (AU)

Absceso de Psoas / Psoas abscess

El absceso de psoas es una entidad infrecuente y suele estar relacionada con patología gastrointestinal. Las manifestaciones clínicas suelen ser inespecíficas por lo que el diagnóstico suele ser tardío y como consecuencia de ello el pronóstico malo. Es importante destacar que ante la presencia de un absceso o enfisema en el muslo se debe tener siempre en cuenta la posibilidad de un origen abdominal, ya que el drenaje quirúrgico urgente y agresivo es el único tratamiento eficaz en estas situaciones (AU)

Psoas abscess is a rare clinical entity often associated with gastrointestinal disease. Clinical manifestations are usually non-specific and therefore diagnosis is delayed leading to poor prognosis. It is important to emphasis that when a patient presents with an abscess or cutaneous emphysema in the muscle the possibility of abdominal origin should always be considered, because immediate, aggressive surgical drainage is the only effective treatment (AU)

Primary psoas abscess extending to thigh adductors: case report.

BACKGROUND: Psoas abscess is a rare condition consisting of pyomyositis of the psoas. The worldwide incidence was 12 cases per 100,000 per year in 1992, but the current incidence is unknown. Psoas abscess can descend along the psoas sheath and reach the inner upper third of the thigh, but only infrequently does it penetrate the sheath and involve the thigh adductors. Because of insidious clinical presentation, the diagnosis of psoas abscess is a challenge. Delayed diagnosis can result in poor prognosis. CASE PRESENTATION: A 45-year-old male with no significant past medical history presented with pain in the left thigh, and limitation of movement at the left hip and knee joint for one month. Ultrasound, CT, and MRI revealed a liquid mass in the left psoas. Percutaneous drainage of this mass yielded 300 ml pus from the psoas. After surgery, the patient reported relief of pain; however, ten days after removal of the drainage tube, the patient complained of persistent pain in his left thigh. CT revealed that the psoas abscess had extended inferiorly, and involved the entire set of adductors of the left thigh. Open surgical drainage was performed at the flank and at the thigh, yielding 350 ml of pus from the thigh. After open drainage and adequate antibiotic therapy, the patient made a good recovery. Follow-up CT confirmed complete resolution of the abscess. CONCLUSIONS: Large psoas abscess can penetrate the psoas sheath, and descend to thigh adductors even after percutaneous drainage. Appropriate treatment includes open surgical drainage along with antibiotic therapy.

Pyogenic psoas abscess: case series and literature review.

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.

Multifocal skeletal tuberculosis in children.

Multifocal bone involvement is though rare but is reported from some countries where tuberculosis is endemic. Here we report a case of three years old boy was admitted in Bangabandhu Sheikh Mujib Medical University, Dhaka with the complaints of difficulty in walking ,low grade fever for six months, swelling over the back, elbow joint, knee joint and upper part of forearm and legs for two months. Family history of tuberculosis was positive. Mantoux test was 18 mm, ESR 85 mm in first hour, chest X-ray reveals right hilar lymphadenopathy, X-ray dorsolumber spine shows wedge shaped deformity in T11, L4 and with paravertebral collection from L2-L4. X-ray of legs, knee joint and forearms show multiple lytic lesions in shaft with periosteal reaction and cortical thickening. Ultrasonograph of whole abdomen shows psoas abscess. Culture of bone marrow aspirate reveals Mycobacterium tuberculosis. Patient was given an anti tubercular regimen with Rifampicin, Isoniazid, Pyrazinamide and Streptomycin for initial two months which to be followed by Rifampicin and Isoniazid for another 10 months.

Septic arthritis of the hip with psoas abscess caused by Non-typhi Salmonella infection in an immunocompetent patient.

Osteoarticular infections caused by Non-typhi Salmonella are exceptionally encountered. We report a case of a bacteriologically documented hip infection associated with a psoas abscess due to Non-typhi Salmonella. A 64-year-old immunocompetent male was admitted in our department for pain and motion range limitation in the right hip with fever. Non-typhi Salmonella was recovered in joint fluid obtained by needle aspiration. Antimicrobial chemotherapy combined with surgical intervention was necessary for eradication of the infection. Physicians should be aware of this rare manifestation of Non-typhi Salmonella infections in non-debilitated patients.

Patologias do compartimento iliopsoas: avaliação radiológica / Iliopsoas compartment lesions: a radiological evaluation

Limite posterior do retroperitônio, o compartimento iliopsoas localiza-se externamente ao mesmo, sendo composto dos músculos psoas maior, psoas menor e ilíaco. O quadro de sintomas dos pacientes com acometimento patológico deste compartimento é amplo e inespecífico, podendo haver importante atraso no diagnóstico. Entretanto, na busca do diagnóstico etiológico das alterações do compartimento iliopsoas, sabemos que as infecções, os tumores e as hemorragias respondem pela quase totalidade das lesões. Por meio da avaliação retrospectiva de exames radiológicos de pacientes com patologias do iliopsoas e que tiveram o diagnóstico confirmado por exame anatomopatológico ou acompanhamento clínico, revisamos a anatomia deste compartimento, assim como as suas principais formas de acometimento, identificando sinais que auxiliem na diferenciação dos potenciais diagnósticos diferenciais. Na abordagem de cada patologia discutiremos os principais sinais radiológicos, como a presença de gás em abscessos piogênicos, alterações ósseas em corpos vertebrais nas lesões secundárias a tuberculose, comprometimento dos planos fasciais nas lesões tumorais e diferenças na densidade e intensidade de sinal dos hematomas nas diferentes fases de degradação da hemoglobina, entre outros. Dessa forma, procuramos apresentar casos que exemplifiquem as doenças mais freqüentes do compartimento iliopsoas, destacando a importância dos seus diferentes sinais, aproximando-nos de um diagnóstico etiológico específico.

The iliopsoas compartment, a posterior boundary of the retroperitoneum, is comprised of the psoas major, psoas minor and iliac muscles. The symptoms picture in patients presenting with pathological involvement of this compartment may show a wide range of nonspecific clinical presentations that may lead to delayed diagnosis. However, in the search of an etiological diagnosis, it is already known that inflammation, tumors, and hemorrhages account for almost all the lesions affecting the iliopsoas compartment. By means of a retrospective analysis of radiological studies in patients with iliopsoas compartment lesions whose diagnosis was confirmed by anatomopathological evaluation or clinical follow-up, we have reviewed its anatomy as well as the main forms of involvement, with the purpose of identifying radiological signs that may help to narrow down the potential differential diagnoses. As each lesion is approached we will discuss the main radiological findings such as presence of gas in pyogenic abscesses, bone destruction and other bone changes of vertebral bodies in lesions secondary to tuberculosis, involvement of fascial planes in cases of neoplasms, and differences in signal density and intensity of hematomas secondary to hemoglobin degradation, among others. So, we have tried to present cases depicting the most frequent lesions involving the iliopsoas compartment, with emphasis on those signs that can lead us to a more specific etiological diagnosis.

Infection-associated hemophagocytic syndrome in a diabetic patient undergoing chronic hemodialysis.

Hemophagocytic syndrome (HPS) is an uncommon but severe illness associated with a variety of infections, malignant tumors, and autoimmune diseases. We report a case of infection-associated HPS in a patient receiving chronic hemodialysis. Peptostreptococcus-induced sepsis and abscess formation in the left iliopsoas muscle led to the onset of infection-associated HPS in this patient. The patient had diabetes mellitus and end-stage renal disease, and it is likely that immunological dysfunctions from these disorders played a part in the onset of both severe bacterial infections and HPS.

Primary psoas abscess. A review of 16 cases.

OBJECTIVE: Most psoas abscesses are secondary. The objective of this study was to report on the clinical features, diagnosis and treatment of primary psoas abscess. METHODS: We retrospectively studied 16 cases seen over a ten-year period (1987-1997) and compared our findings to published data. RESULTS: There were 14 men and two women, with a mean age of 6 years (range, 17-57 years). The right side was affected in nine cases, the left side in six, and both sides in one. Fever, pain and psoas spasm were the presenting symptoms. Laboratory tests for inflammation were positive; four patients had a high neutrophil count. Ultrasonography demonstrated a fluid collection in the psoas in 13 patients. A computed tomography scan was done in 14 patients and showed either a fluid collection (n = 11) or a presuppurative abscess (n = 3). Magnetic resonance imaging was not used. The organism was recovered in nine patients and was a Staphylococcus aureus in seven, an Escherichia coli in one and a Pseudomonas aeruginosa in one. The Brucella agglutination test was strongly positive in two patients. Findings were negative from investigations done to look for a cause (discitis, urinary tract infection, Crohn's disease, ulcerative colitis, malignancy or infection in the vicinity of the psoas muscle). All patients received antimicrobial therapy. Drainage was percutaneous in six patients and surgical in ten. The outcome was favorable in every case.

Psoas abscess with sepsis mimicking traumatic hemorrhagic shock after a fall.

Abscess of the psoas muscle is infrequently encountered. An infectious emergency of this type usually presents in a nonspecific manner and thus poses a significant diagnostic challenge to the emergency physician. Diagnosis and specific treatment are often delayed, which can lead to increased mortality. This case report presents a patient with altered mental status and hypotension after a fall, who was initially managed as a trauma victim. Emergency department evaluation initially focused on a traumatic etiology of the above abnormalities. Subsequent assessment determined that the patient's condition was due to an underlying psoas abscess with sepsis. Appropriate anatomy, clinical presentation, and management are discussed in hopes of increasing physician awareness of this uncommon infectious condition.