Limitations of Using Imaging Diagnosis for Psoas Abscess in Its Early Stage

Takada, Toshihiko; Terada, Kazuhiko; Kajiwara, Hideki; Ohira, Yoshiyuki

doi:10.2169/internalmedicine.54.4927

Cited by 23 publications

(21 citation statements)

References 10 publications

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“…MRI and CT are considered to be "gold standard" imaging tecniques for demonstrating IPA. 11 We preferred MRI because, MRI is superior to CT in displaying soft tissues, and also does not require intravenous contrast material.…”

Section: Discussionmentioning

confidence: 99%

Iliopsoas Abscess with Septic Arthritis of the Hip Following Trauma: Case Report

Aygün¹,

Bektaş²,

Çokuğraş³

et al. 2017

Turkiye Klinikleri J Case Rep

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Section: Discussionmentioning

confidence: 99%

Iliopsoas Abscess with Septic Arthritis of the Hip Following Trauma: Case Report

Aygün¹,

Bektaş²,

Çokuğraş³

et al. 2017

Turkiye Klinikleri J Case Rep

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“…3,15,18,19 CT imaging provides a definitive diagnosis for psoas abscess, although sensitivity may be limited early in the disease. 8,16,19,25,28 Other findings may include a focal hypodense lesion, infiltration of surrounding fat, and gas or air within the muscle. 28 In this athlete, the avulsion fragment noted at the lesser trochanter on CT may have misled physicians, suggesting that pain was due to acute hip flexor injury, lowering infection on our differential.…”

Section: Discussionmentioning

confidence: 99%

A Pain in the Psoas

Moriarty¹,

Baker

2016

Sports Health: A Multidisciplinary Approach

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General medical conditions are an important part of the differential diagnosis in athletes presenting with pain or injury. A psoas abscess is a collection of pus in the iliopsoas muscle compartment and is a rare cause of hip, low back, or groin pain. Psoas abscesses may have significant morbidity and mortality, as 20% progress to septic shock. Presenting symptoms are generally nonspecific and the onset may be subacute. Clinical presentation may have features suggestive of other diagnoses, including septic hip arthritis, iliopsoas bursitis, and retrocecal appendicitis. Proper diagnosis and management is critical to prevent complications of septic shock and death. In this unique case, a 19-year-old Division 1 collegiate football player presented to the emergency department 4 days following injury to his right groin during football practice. He complained of severe right groin pain accompanied by fatigue, fevers, nausea, and diarrhea. He later developed septic shock with multisystem organ dysfunction, requiring advanced life support. Imaging revealed an abscess located in the right iliopsoas compartment. After proper treatment, the athlete eventually made a complete recovery, returning to collegiate football 4 months postinjury. A literature review found no described cases of psoas abscess related to athletes with acute hip flexor strain. This athlete had no known risk factors for psoas abscess. This case highlights the importance of maintaining a broad differential in an athlete presenting with pain after injury. Making the diagnosis of psoas abscess often requires a high degree of suspicion and timely acquisition of imaging studies. In this particular case, imaging was key to making a proper diagnosis and tailoring treatment not only to return him to sport but also to save his life.

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“…The incidence of Psoas abscess is estimated to be approximately 12 cases per year in the world, although this incidence is having an upward trend due to increased availability of Section: Radiology imaging techniques like Computerised tomography (CT Scan) and Magnetic Resonance Imaging (MRI). [3] Psoas abscess is divided into primary and secondary on the basis of whether they are due to a bacteremia distant to ilio-psoas muscle (primary Psoas abscess) or because of a direct spread of infection to the ilio-psoas muscle by contiguity from an adjacent structure like sigmoid colon, appendix, jejunum, ureters, kidneys, pancreas and spine (secondary Psoas abscess). The fact that Psoas muscle is rich in blood supply makes it predisposed to hematogenous spread from other sites of infection.…”

Section: Name and Address Of Corresponding Authormentioning

confidence: 99%

Psoas Abscess: Imaging Diagnosis of A Rare Entity

Kulkarni¹,

Aafreen²,

Shetkar³

et al. 2018

AIMDR

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Psoas abscess (PA) is a rare infection which may present as pus collection in the ilio-psoas muscle compartment. Mynter et al described this entity for the first time in 1881. Its incidence is so rare that less than 15 patients are diagnosed every year in whole world. It is not only a rare infection but also it is an under diagnosed entity because of its non-specific and vague symptomatology. These abscesses are many times under-diagnosed despite availability of improved diagnostic modalities. The diagnosis require a high index of suspicion specially in patients of diabetes, patients on immunosuppressants, individuals receiving chemotherapy and patients with acquired immunodeficiency syndrome. The Psoas abscesses are divided into primary and secondary PA on the basis of the etiology. The exact etiology of primary Psoas abscess is not known but it is thought to be secondary to hematogenous spread. The secondary Psoas abscess is thought to be secondary to spread of infection from the adjacent sites like from pott's spine or secondary to urinary tract infection, post spine-surgery, in patients with mycotic aneurysms, individuals with endocarditis and pyogenic osteomyelitis etc. The common organisms involved in PA include S.Aureaus, E.Coli, Bacteroids, M.Tuberculosis, Enterococcus and peptostreptococcus. Patients may present with the classical triad of Pain, Fever and Limp. A timely diagnosis and immediate and aggressive treatment is essential as these abscesses carry a very high mortality if not treated in time. The imaging techniques which may be used for the diagnosis include Ultrasound Imaging, Computerised Tomography and Magnetic Resonance Imaging. Plain Radiographs are usually unremarkable. The fact that Psoas muscle abscess are located in the retrofascial space rather than in the retroperitoneal space makes its diagnosis difficult on ultrasound examination and approximately 40% of the times the diagnosis of Psoas abscess is missed on ultrasonography. Diagnosis by CT and MRI is relatively easy and almost all cases can be diagnosed on the basis of CT or MRI. Unenhanced CT may show presence of abscess within the Psoas muscle. A CT-Scan with oral and IV contrast may be needed in some cases of Psoas abscess where the abscess is suspected to be secondary. CT may also help in CT Guided drainage of abscess which may have diagnostic (culture and sensitivity) and therapeutic implications. MRI may provide better visualization of abscess than CT scan moreover MRI can simultaneously rule out other causes of low back pain. In some advanced centers gallium-67 scanning is being used for the diagnosis of Psoas abscess but its routine use is not feasible in developing countries like that of India. We are reporting here a case of Psoas abscess in 25 year old female who were sent for referred to us for CT abdomen. She had a history of fever, right flank pain, nausea and referred pain to groin. We diagnosed her to be having Psoas Abscess on the basis of imaging findings. Patient received appropriate treatment in the form of draina...

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Limitations of Using Imaging Diagnosis for Psoas Abscess in Its Early Stage

Cited by 23 publications

References 10 publications

Iliopsoas Abscess with Septic Arthritis of the Hip Following Trauma: Case Report

Iliopsoas Abscess with Septic Arthritis of the Hip Following Trauma: Case Report

A Pain in the Psoas

Psoas Abscess: Imaging Diagnosis of A Rare Entity

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