Diagnosis and treatment of pyogenic psoas abscess in diabetic patients: Usefulness of computed tomography and gallium-67 scanning (original) (raw)
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Psoas Abscess – the Changing Trends
International Journal of Medical Science And Diagnosis Research, 2021
Introduction: Psoas abscess (IPA) is an abscess collection in the retroperitoneal space tracking along the psoas major muscle. The microbial etiology of Psoas abscess is variable and depends on the geographical area. This study attempts to evaluate the microbial etiology, its implication in deciding the management modalities, and outcomes in patients with Psoas abscess from a tertiary care center in South India. Materials and Methods: This was a retrospective study done in a tertiary care center in Southern India. Results: A total of 47 patients were enrolled in the study, with causative organism identified in 40 (85.15%) patients. In 17 patients (36.17%), it was found to be tuberculous origin; and of nontuberculous origin in 23 patients (48.93%). No causative organism could not be isolated in 7 patients (14.89%). While 33 patients were treated with percutaneous drainage (70.12%), open drainage was done in 14 patients (29.78%) and 1 patient died (2.12%). Conclusion: The most common ...
Canadian Journal of Medicine (CJM), 2024
Psoas abscess is a relatively rare condition with varying clinical presentation. Therefore, the diagnosis and treatment are frequently delayed. Psoas abscess can extend into the spine and cause spinal infection or spinal infection can be a source for secondary psoas abscess. It has 100% mortality if left untreated. Broad-spectrum antibiotics and drainage of pus by either percutaneous drain insertion or open surgery are the treatment modalities. A 62-year-old patient, male patient with long-standing diabetes and ischemic heart disease presented with fever and lower back pain for four days duration without any systemic focus of infection. He was hemodynamically stable, and neurological examinations of the lower limb were normal on admission. He developed bilateral lower limb weakness on the 7th day of hospital stay, and neurological examinations of the lower limb revealed flaccid paralysis. His Contrast Enhanced Computerized Tomography (CECT) of the abdomen revealed a bilateral psoas abscess. Both pus culture and blood culture were positive for Methicillin-resistant staphylococcus aureus. Later, his Magnetic Resonance Image (MRI) spine revealed infective multilevel spondylodiscitis, arachnoiditis, radiculitis, and early infective myelitis. The abscess was drained, and a broad-spectrum antibiotic was started. Unfortunately, he passed away despite maximal medication intervention due to septicemia, acute kidney injury, and septic shock. Even though rare, psoas abscess should be suspected in a patient with back pain, fever, and high inflammatory markers due to its high mortality and morbidity. Early diagnosis and treatment can reduce mortality and morbidity. However, advanced age, presence of bacteremia, and poorly controlled diabetes carry poor prognosis.
Psoas Abscess: Evaluation of 15 Cases and Review of the Literature
Journal of Urological Surgery, 2014
Psoas abscess (PA) is a rare disease, presenting with high mortality and morbidity particularly when diagnosed late. PA should be considered in patients who had history of abdominal surgery and high fever resistant to treatment. Early diagnosis and treatment may decrease high mortality and morbidity rate. Contrary the literaure which stated that PA is more commen in patients younger than 20, we found the mean age as 58.5.
An Atypical Case of Psoas Abscess in an Elderly Patient
European Journal of Geriatrics and Gerontology
Psoas abscess (PA), the accumulation of suppurative fluid in the fascia surrounding the psoas muscle, is a rare condition, with difficult diagnosis. Pain, fever, and limping are its main symptoms. In this paper, we report a case of PA presenting with non-specific symptoms, such as pain and fatigue. After the diagnosis, drainage of PA was performed, and intravenous antibiotic treatment was started immediately. The patient was discharged with improvements in his general condition after three weeks of treatment. This case suggests that PA should be considered in geriatric patients presenting with nonspecific symptoms such as fatigue, loss of appetite and weight loss as well as waist and hip pain. Early diagnosis may significantly decrease the risk of morbidity and mortality.
Psoas abscess rarely requires surgical intervention
The American Journal of Surgery, 2008
BACKGROUND: Surgeons are increasingly encountering psoas abscesses. METHODS: We performed a review of 41 adults diagnosed and treated for psoas abscess at a county hospital. Treatment modalities and outcomes were evaluated to develop a contemporary algorithm. RESULTS: Eighteen patients had a primary psoas abscess, and 23 had a secondary psoas abscess. Patient characteristics were similar in both groups. Intravenous drug abuse was the leading cause of primary abscesses. Secondary abscesses developed most commonly after abdominal surgery. Treatment was via open drainage (3%), computed tomography-guided percutaneous drainage (63%), or antibiotics alone (34%). Four recurrences occurred in the percutaneous group. Statistical analysis showed that the median size of psoas abscesses in the percutaneous group was significantly larger than in the antibiotics group (6 vs 2 cm; P Ͻ .001). The mortality rate was 3%. CONCLUSIONS: Initial management of psoas abscesses should be nonsurgical (90% success). Small abscesses may be treated with antibiotics alone, and surgery can be reserved for occasional complicated recurrences.
A case report of a septic hip secondary to a psoas abscess
Journal of Orthopaedic Surgery and Research, 2010
Psoas abscess was first described by Mynter in 1881. Though rare, its prevalence is increasing with advances in radiology and an increasing ability to accurately diagnose the condition. The symptoms of a psoas abscess can be insidious and nonspecific, and patients often present with a limp, fever, weight loss, and flank or abdominal pain. A psoas abscess can be classified as either primary or secondary depending on the presence or absence of an underlying disease. Primary psoas abscess has become more prevalent in the developed world, especially in immuno-compromised patients. We present the case of a 48 year old man who presented with fever, left hip pain and difficulty weight-bearing. He had a past medical history of chronic renal failure secondary to hypertension. Following laboratory, radiological and microbiological analyses the patient was diagnosed as having a Staphylococcus Aureus hip sepsis secondary to a psoas abscess. Psoas abscess should be included as a differential diagnosis in all patients presenting with hip pain and constitutional symptoms. The case is discussed with reference to the literature.
Psoas abscess in hemodialysis patients
International Urology and Nephrology, 2010
Background The insidious onset and occult characteristic of psoas abscess can cause diagnostic delays, resulting in high mortality and morbidity rates. Here, we investigated the characteristics of psoas abscess in hemodialysis patients. Methods This study was carried out in eight patients with psoas abscess who were admitted in our hospital. The clinical data were retrospectively collected.
Characteristics and Outcomes of Psoas Abscess: Experience From a Tertiary Care Center in North India
Cureus, 2022
Background Psoas abscess (PA) is an uncommon disease involving infection of the psoas muscle with abscess formation. The evidence concerning clinical and diagnostic characteristics of PA and its outcomes is limited. The literature is heterogenous, with varying presentations and outcomes in different regions worldwide. We present a retrospective analysis of the clinical, radiological, and laboratory characteristics of PA, its management, and outcomes from a tertiary care center in North India. Methodology We reviewed the clinical records of confirmed cases of PA treated in our institute from January 2016 to December 2020 with a minimum follow-up of one year. Further, we performed a descriptive analysis of demographic characteristics, clinical features, laboratory parameters, radiological investigations, the basis of diagnosis confirmation, causative microorganisms, definitive management, treatment outcomes, and complications. Results We reviewed 33 cases with a mean age of 29.9 ± 16.8 years. Overall, 48.4% of PAs were right-sided, and 24.2% were bilateral. Abdominal discomfort was the most common presenting symptom. Blood laboratory parameters were mostly within the near-normal range except for the elevated erythrocyte sedimentation rate, C-reactive protein, and neutrophil-to-lymphocyte ratio. Ultrasonography was the most commonly performed radiological investigation and was the basis of diagnosis confirmation. Mycobacterium tuberculosis was the most common causative microorganism. Most patients required percutaneous drainage, and around one-fourth required open drainage. All patients had symptomatic as well as radiological improvement and no major complications. Conclusions Tuberculosis is the most prevalent cause of PA in the North Indian population. Most patients respond well to the less invasive treatment with percutaneous therapeutic drainage and antitubercular drugs, with few patients requiring open drainage. However, tissue diagnosis may remain inconclusive in a few patients, and antitubercular treatment may need to be initiated based on the clinicoradiological evaluation. Nevertheless, the rate of complications is low, with nil mortality probably related to the mild-to-moderate disease course of tuberculosis.
Psoas abscess in Bristol: a 10-year review
International Journal of Colorectal Disease, 1987
A consecutive series of 16 cases of psoas abscess managed over a 10-year period at the Bristol Royal Infirmary is presented. Tuberculosis accounted for 4 patients all normally resident in the United Kingdom. Intrabdominal inflammatory disorders accounted for 9 of the cases with Crohn's disease being the commonest of these with 5 cases. The remaining patients comprised 3 with primary staphylococcal abscesses, one appendicitis, one diverticulitis and 2 with colonic carcinoma. Diagnostic delay was common. Ultrasonography together with guided aspiration of pus was the most useful investigation giving the diagnosis in cases due to tuberculosis and staphylococci. The presence of gut associated organisms was indicative of gastrointestinal pathology. Four patients died and significant morbidity occurred in a further 5. We recommend effective dependent drainage together with resection of diseased gut in the cases of gastrointestinal origin.