Psoas abscess associated with iliac vein thrombosis and piriformis and gluteal abscesses

Abstract

Background: A 14-year-old boy was admitted because of lumbago and high fever. Methods/Results: Computed tomography scans revealed psoas, piriformis and gluteal abscesses as well as right iliac vein thrombus. A right femoral venogram demonstrated compression from the psoas abscess and thrombosis of the common iliac vein. Appropriate surgical drainage, administration of antibiotics and anticoagulant therapy were effective in the present case. Conclusions: This is the first report of primary psoas abscess associated with vein thrombosis and is also unique in that abscesses were multiple without predisposing diseases or trauma.

Brief review: Piriformis syndrome: etiology, diagnosis, and management

“…• Dysfunction, lesion, and inflammation of sacroiliac joint 3,7,9,63,64 • Pseudoaneurysm in the inferior gluteal artery following gynecologic surgery 4,65 • Thrombosis of the iliac vein 18,51,65 • Painful vascular compression syndrome of the sciatic nerve, caused by gluteal varicosities 6 • Herniated intervertebral disc 67 • Post-laminectomy syndrome or coccygodinia 18,41 • Pseudoradicular S1 syndrome 45 • Posterior facet syndrome at L4-5 or L5-S16 3…”

“…• Gluteal trauma in the sacroiliac or gluteal areas (possibly several years previously) 13,22,33 • Predisposing anatomic variants 4,5,7,14,15,40,41 • Myofascial trigger points 7,20,38,39,42 • Hypertrophy and spasm of the piriformis muscle 14,18,[43][44][45] • Secondary to laminectomy 13,38,39,43,[46][47][48][49][50] • Abscess, 51 hematoma, 52,53 myositis, 54 bursitis of the piriformis muscle, 55 neoplasms in the area of the infrapiriform foramen, 56 colorectal carcinoma, 57 neurinoma of the sciatic nerve, 18 episacroiliac lipoma 50 • Intragluteal injection 58 • Femoral nailing 18 • Myositis ossificans of the piriformis muscle 3,59 • Klippel-Trénaunay syndrome 18 Table 2 Differential diagnosis of piriformis syndrome…”

Rare Etiological Causes of Iliofemoral Deep Venous Thrombosis: Reports of 2 Cases

“…This was proposed to be the best method of treatment. 7 Another psoas abscess in a patient with signs of Phlegmasia Cerulea Dolens also underwent percutaneous drainage. 8 The primary factors causing DVT in malignancy patients are mass effect, paraneoplastic effects, and chemotherapy.…”

Psoasabszesse

“…Im Rahmen der Thromboseabklärung fiel bei diesen Patienten eine durch den Psoasabszess verursachte Kompression der V. iliaca mit nachfolgender Abflussstauung auf [1].Anhand dieses Beispieles lässt sich die Variabilität des klinischen Bildes eines Psoasabszesses aufzeigen,sodass eine Diagnose aufgrund der klinischen Symptomatik kaum möglich ist.…”