Acute Psoas Abscess

Abstract

The great majority of psoas abscesses are chronic in nature, and usually secondary to a tuberculous focus in the vertebral column or pelvic bones. A certain number, however, are more acute. The fact that the correct diagnosis is seldom made in these cases seems to be due mainly to the possible existence of the condition not being realized for the clinical signs are constant and characteristic. Although the older textbooks, such as Erichsen's Surgery, contain a fairly comprehensive list of the possible sites of origin of psoas abscesses other than the spine, and the signs which may be of help in their differential diagnosis, most of the modern textbooks give the impression that the condition is practically always associated with spinal disease. Some of them do not even mention any other cause, while others briefly refer to the possibility of the abscess being secondary to lesions such as suppurative appendicitis, perinephritis, or sacro-iliac disease. The references in the literature are scanty, but there are indications that this is due more to the condition being overlooked than to its rarity.

Increasing incidence of iliopsoas abscesses with MRSA as a predominant pathogen

“…Traditional anatomic classification categories of primary and secondary IPA were used. 8 Primary IPAs were defined as an infection from presumed hematogenous dissemination from a distant site of infection, and a secondary IPA as an infection caused from direct spread of a contiguous infectious source. Cases were further classified by microbial diagnosis.…”

“…' 7 In the pre-antibiotic era, Mycobacterium tuberculosis represented the primary pathogen in most cases. 8 However, modern disease has traditionally been characterized by source of infection with Staphylococcus aureus as the leading cause of bacteremic origin, while enteric pathogens are most commonly identified due to adjacent infectious foci. 4,9,10 A prior report of 11 cases from our institution from 1987 to 1994 suggested an escalating number of IPA cases caused by methicillin-susceptible S. aureus ascribed to hematogenous sources.…”