Ultrasound, computed tomography and magnetic resonance in the investigation of iliopsoas compartment disease

Abstract

The authors reviewed the results of imaging studies performed in 30 patients with diseases involving the iliopsoas compartment (IPC) to assess the role of Ultrasound (US), Computed Tomography (CT) and Magnetic Resonance (MR) in the investigation of these deep seated and often clinically undetectable lesions. 16 (53%) patients had histologically proven benign or malignant IPC tumours with bacterial infection in 12 (40%) and haemorrhage into the IPC in 2 (7%). US correctly detected iliopsoas pathology in only 9 of 17 cases (53%) and was satisfactory only in limited situations, such as abscess formation in children and haemorrhage in haemophiliacs. CT was much more accurate (16/17, 94%) than US and correctly diagnosed 7 cases overlooked on US, while also offering greater information in 5 cases where both studies were abnormal. CT was particularly helpful for the detection of both abscess formation and calcification within mass lesion. MR was accurate in all 9 cases imaged, and was very helpful in the assessment of associated vertebral, disc or spinal canal involvement by tumour or infection. A review of the literature, and the results of this study, suggest that CT and MR often have complementary roles where IPC disease is known or suspected. The accuracy of US in IPC disease is limited, preferably being followed by CT or MR imaging.

Increasing incidence of iliopsoas abscesses with MRSA as a predominant pathogen

“…21,22 While these etiologies may explain a small proportion of the culture negative cases, the majority of cases are likely due to sterilized infection rather than misclassification given the good sensitivity of radiologic detection by CT and MRI for infections at that body site. 23,24 Furthermore, 60% of patients with no microbial diagnosis obtained had received antimicrobial therapy within thirty days of admission, suggesting that prior antibiotic use may have decreased the yield of the obtained culture data or may have sterilized the sites of infection. In this study, data were not collected regarding the relationship of inpatient antimicrobial therapy administration and the timing of drainage procedure.…”

Primary malignant tumors of the iliopsoas compartment

“…Metastatic tumors from the testis, cervix, kidney, bladder, and prostate commonly involve this area. Direct extension of colorectal, gynecological, occasionally urological tumors, lymphomas, and soft tissue origin tumors also occur [1,2].…”

“…A wide range of infective, hemorrhagic, and neoplastic processes can involve the iliopsoas compartment [1]. Metastatic tumors from the testis, cervix, kidney, bladder, and prostate commonly involve this area.…”

“…The surgical principles involved in the management of iliopsoas tumors have been discussed by Spillane [4]. There has been literature on the role of CT and magnetic resonance imaging in diagnosis, with ultrasound having a limited role [1,2]. There has been no clinical series, till now, in the world literature.…”

“…The iliopsoas compartment is a rare site for soft tissue sarcoma [1,2]. This is a small subset of retroperitoneal soft tissue sarcoma localized to the iliopsoas compartment.…”