Outcome of Percutaneous Ultrasound Guided Aspiration versus Open Surgical Drainage of Psoas Muscle Abscess

Khatoon, Shahida; Ahmedani, Ayesha; Unar, Sanam Karim; Memon, Riaz A.; Khatti, Shahnawaz; Sundesh,

doi:10.48036/apims.v17i2.536

Cited by 2 publications

(3 citation statements)

References 8 publications

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“…Psoas muscle abscess (PMA) is an uncommon yet severe infection characterized by pus accumulation within the iliopsoas muscle, which can lead to significantly high morbidity and mortality rates. Despite its rarity, with an incidence reported as four in one million annually in the UK and a mortality rate reaching up to 19% [ 1 , 2 , 3 , 4 ], males are more commonly affected than females, with a ratio of 1.62:1 [ 5 , 6 ]. PMA poses diagnostic and management challenges, mainly due to its varied etiology and vague clinical presentation with nonspecific symptoms, such as fever, limited hip movement, and back pain, which are present in only 30% of cases [ 4 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…Following the indications put forth by [ 20 ], open surgical drainage (OS) is recommended in cases where percutaneous drainage (PD) proves ineffective, when PD poses relative contraindications specifically when the abdominal condition presents with another disease that necessitates surgical intervention, such as Crohn’s disease, or when dealing with multiloculated abscesses [ 3 ]. It has been noted that open surgical drainage tends to yield superior outcomes concerning achieving complete drainage compared to PD [ 5 ]. PD is more effective and less invasive than open surgical drainage.…”

Section: Introductionmentioning

confidence: 99%

“…It is the method of choice for drainage and the primary initial treatment [ 15 , 21 , 22 , 23 , 24 ]. PD is often image-guided, where imaging modalities such as US, CT, and MRI guidance can be used [ 5 , 21 ]. The use of these imaging methods in guiding PD has been highly recommended lately.…”

Section: Introductionmentioning

confidence: 99%

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Evaluating Imaging Techniques for Diagnosing and Drainage Guidance of Psoas Muscle Abscess: A Systematic Review

Al-Khafaji,

Al-Smadi,

Al-Khafaji

et al. 2024

JCM

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Background: Psoas muscle abscess (PMA) is an uncommon yet severe condition characterized by diagnostic and therapeutic challenges due to its varied etiology and nonspecific symptoms. This study aimed to evaluate the effectiveness and accuracy of various imaging techniques used in the image-guided percutaneous drainage (PD) of PMA. Methods: A systematic review was conducted following the PRISMA guidelines. We searched PubMed, Google Scholar, and Science Direct for studies published in English from 1998 onwards that reported on the use of PD in treating PMA, detailing outcomes and complications. Imaging modalities guiding PD were also examined. Results: We identified 1570 articles, selecting 39 for full review. Of these, 23 met the inclusion criteria; 19 were excluded due to unspecified PMA, absence of imaging guidance for PD, or inconclusive results. Eleven studies utilized computed tomography (CT) for PD, with six also using magnetic resonance imaging (MRI). Ten studies implemented ultrasound (US)-guided PD; variations in diagnostic imaging included combinations of US, CT, and MRI. A mixed approach using both CT and US was reported in two articles. Most studies using CT-guided PD showed complete success, while outcomes varied among those using US-guided PD. No studies employed MRI-guided PD. Conclusions: This review supports a multimodal approach for psoas abscess management, using MRI for diagnosis and CT for drainage guidance. We advocate for Cone Beam CT (CBCT)-MRI fusion techniques with navigation systems to enhance treatment precision and outcomes, particularly in complex cases with challenging abscess characteristics.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evaluating Imaging Techniques for Diagnosing and Drainage Guidance of Psoas Muscle Abscess: A Systematic Review

Al-Khafaji,

Al-Smadi,

Al-Khafaji

et al. 2024

JCM

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Primary Iliopsoas Abscess and Drug-Induced Liver Injury in the Emergency Department: A Case Report

Mederle,

Sima,

Popa

et al. 2024

Diseases

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Background and objective: Iliopsoas abscess (IPA) is a rare condition with varied symptomology and etiology. Less than one-third of patients with IPA present in the emergency department (ED) with the traditional triad of fever, back pain, and restricted hip motion (or limp), leading to delays in diagnosis and management. Acute liver failure is also a rare clinical presentation in the ED, being associated with high morbidity and mortality. It occurs most often in young patients without pre-existing liver disease, presenting unique challenges in clinical management. Most cases currently happen because of drug-induced liver injury (DILI), mainly from acetaminophen or idiosyncratic drug reactions. This case report aims to raise awareness among healthcare professionals regarding the two atypical presentations in ED and introduce a potential differential diagnosis when evaluating patients with fever and back pain or liver enzyme elevations with or without nonspecific symptoms associated with the development of jaundice. The intention is to provide insights into the signs and symptoms that may indicate the presence of an iliopsoas abscess and prompt additional investigations. Case report: Here, we describe a case of primary iliopsoas abscess associated with drug-induced liver injury in our ED. The patient complained of pain in the left lumbar region and fatigue that started two weeks before this presentation, claiming that, during the previous night, the pain suddenly worsened. At the first clinical examination in the ED, the patient presented pain at palpation in the right hypochondriac and left lumbar regions, accompanied by fever, vomiting, and jaundice. On abdominal ultrasonography, the diagnosis of acute cholangitis was suspected. The laboratory test shows leukocytosis with neutrophilia, thrombocytosis, elevated liver enzymes, and hyperbilirubinemia with the predominance of indirect bilirubin. After analyzing the laboratory test results, we repeated and performed a more detailed anamnesis and medical history of the patient. Because of her increasing pain and persistent fever, she recognized excessive consumption in the last five days of drug-induced hepatotoxicity. We performed abdominal and pelvic computed tomography, which confirmed the diagnosis of cholelithiasis observed with the diameter of the bile duct within normal limits but also showed an abscess collection fused to the interfibrillar level of the left iliopsoas muscle, a diagnosis we most likely would have missed. The patient was hospitalized in the General Surgery Department, and surgical abscess drainage was performed. The patient’s evolution was excellent; she was discharged after 11 days. Conclusions: The case presented here exemplifies how iliopsoas abscess, a rare cause of back pain, can quickly go unrecognized, especially in the emergency department. Our experiences will raise awareness among doctors in emergency departments about this uncommon but essential diagnosis. With advancements in diagnostic tools and techniques, we hope that more cases of iliopsoas abscess will be accurately diagnosed. Moreover, no case report from the literature has presented IPA associated with DILI. This case is unique because our patient did not exhibit classic features of either pathology. This case also emphasizes the importance of a medical history that includes thorough evaluations of potential high utilization of drug-induced hepatotoxicity.

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Outcome of Percutaneous Ultrasound Guided Aspiration versus Open Surgical Drainage of Psoas Muscle Abscess

Cited by 2 publications

References 8 publications

Evaluating Imaging Techniques for Diagnosing and Drainage Guidance of Psoas Muscle Abscess: A Systematic Review

Evaluating Imaging Techniques for Diagnosing and Drainage Guidance of Psoas Muscle Abscess: A Systematic Review

Primary Iliopsoas Abscess and Drug-Induced Liver Injury in the Emergency Department: A Case Report

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