Transcript Iliopsoas Abscesses

Iliopsoas Abscesses
Jeremy Lynch
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Case
 66 year old female former secretary
 6 month history of increasing right loin and hip pain
 Recently saw an orthopaedic surgeon who ascribed the hip
symptoms to age
 For past 2 days:
 Severe exacerbation of pain
 Fever
 Nausea
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Examination
 Pyrexial
 Tachycardic
 BP: 100/72
 Swelling, and tenderness localized at the right side at
the back of waist
 Most comfortable with right hip in flexion
 Extension especially painful
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Investigations
 Raised WCCs, CRP, mild anaemia
 CXR/AXR: nil of note
 Ultrasound pelvis/abdomen: nil of note
 CT shows: hypodense lesion causing enlargement of
the psoas muscle
 Diagnosis of psoas abscess made
 Treated with CT guided drainage
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Definition
 Collection of pus in the iliopsoas compartment
Psoas Major
Iliacus
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Aetiology
1. Primary: haematogenous spread of bacteria from
distant source
2. Secondary: inflammatory/infectious process nearby
 Growing in frequency with growing use of CT
scanning
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Primary Causes
Haematogenous spread of bacteria
Risk Factors
Diabetes mellitus
AIDS
Renal Failure
Immunosuppression
IV drug abuse
Older patients
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Secondary Causes
Inflammatory/infectious process
System
Cause
Gastrointestinal
Crohns, Diverticulitis, Appendicitis, Colorectal Cancer
Genitourinary
UTI, Cancer, Extracorporeal Shock Wave Lithotrypsy
Muskuloskeletal
Verterbral osteomyelitis, Septic arthritis, Infected sacroilitis
Vascular
Infected AAA, Femoral catheterization
Miscellaneous
Endocarditis, IUD
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Epidemiology
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Clinical Features
Fever
Limp
Back Pain
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Examination
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Investigations
 Bloods
 CRP/ESR
 FBC
 Cultures
 Radiological
 Plain films
 Ultrasound
 CT/MRI
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Management
 Antibiotics
 CT Drainage
 1984 first attempted
 Wael, 2008: 41 adults
 Problem of recurrence: 15%
in Wael study
 Surgical Drainage:
 Significant morbidity
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Message
 Diagnosis is difficult and often delayed
 Diagnosed more frequently now due to CT
 Dangerous if untreated
 Thorough clinical examination can suggest
 Repeated imaging often needed to confirm
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References
 Mallick, Thoufeeq, Rajendran. Iliopsoas Abscesses.
Postgrad Med J. 2004. 80:459-462
 M. Cantasdemir, B. Kara, D. Cebi, N. D. Selcuk and F.
Numan. Psoas abscess rarely requires surgical
intervention. The American Journal of Surgery. 2003.
58:811
 Ricci, M.A., Rose, F.B., Meyer, K.K. Pyogenic psoas
abscess: Worldwide variations in etiology. World
Journal of Surgery. 1986. 10:834
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