Psoas abscess: Difference between revisions

(Created page with "==Background== *Psoas muscle is susceptible to infection from distant sites due to: **Rich blood supply **Proximity to overlying retroperitoneal lymphatic channels *S. aureus is ...")
 
 
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==Background==
==Background==
*Psoas muscle is susceptible to infection from distant sites due to:
[[File:Anterior Hip Muscles 2.png|thumb|Psoas major and nearby muscles.]]
**Rich blood supply
[[File:Gray1038.png|thumb|Horizontal disposition of the peritoneum in the lower part of the abdomen, showing psoas major.]]
**Proximity to overlying retroperitoneal lymphatic channels
*Primary infection
*S. aureus is most common pathogen (80%)
**Psoas muscle is susceptible to infection from distant sites due to rich blood supply, proximity to overlying retroperitoneal lymphatic channels
*Secondary infection
**Direct spread/extension via adjacent infection
**[[S. aureus]] is most common pathogen (80%)


==Clinical Features==
==Clinical Features==
[[File:PMC3232364 cios-3-342-g001.png|thumb|Late finding of a large psoas abscess progressing to visible left buttock mass with erythematous skin eruption.]]
*Abdominal pain radiating to hip, flank
*Abdominal pain radiating to hip, flank
*Pain with thigh flexion (esp against resistance)
*Pain with thigh flexion (esp against resistance)
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*Fever
*Fever
*Nausea
*Nausea
*Back pain<ref>Dietrich A, Vaccarezza H, and Vaccaro CA. “Iliopsoas abscess: presentation, management, and outcomes,” Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, vol. 23, no. 1, pp. 45–48, 2013.</ref>
==Differential Diagnosis==
{{Hip pain DDX}}
{{Abd DDX RLQ}}
{{Template:LLQ DDX}}
==Evaluation==
[[File:ParaspinalabscessCorMark.png|thumb|Psoas muscle abscess on CT.]]
[[File:ParaspinalabscessMark.png|thumb|Psoas muscle abscess on CT.]]
[[File:PMC3232364 cios-3-342-g002.png|thumb|(A) Abdominal computed tomography, revealing abscess formation on the left psoas muscle, which was depicted as a localized low density area. (B) Magnetic resonance imaging shows multiseptated psoas abscess and gluteal abscess.]]
===Work Up<ref>Shields D, Robinson P, Crowley TP. “Iliopsoas abscess—a review and update on the literature,” International Journal of Surgery. 2012; 10(9): 466–469.</ref>===
*Lab Studies
#CBC
#Chem-10
#Lactic
#Blood cultures
*CT abdomen/pelvis with contrast (imaging study of choice)<ref>Hosn S. Psoas muscle abscess. Radiology Reference Article. Radiopaedia.org. Radiopaediaorg. 2015. Available at: http://radiopaedia.org/articles/psoas-muscle-abscess. Accessed May 21, 2015.</ref>
*MRI has higher sensitivity (if available)<ref>Hosn S. Psoas muscle abscess. Radiology Reference Article. Radiopaedia.org. Radiopaediaorg. 2015. Available at: http://radiopaedia.org/articles/psoas-muscle-abscess. Accessed May 21, 2015.</ref>
*Lower accuracy with US
*MRI or US preferred in pregnant patients
===Diagnosis===
*Typically on imaging


==Management==
==Management==
*CT is imaging study of choice
*[[Antibiotics]]
*Abx, surgical consultation
**[[Vancomycin]] plus
**[[Piperacillin/tazobactam]] 3.375g, '''OR'''
**[[Ceftriaxone]] + [[Metronidazole]]
*Ultimate treatment is surgical drainage: Surgery or IR consultation


==Source==
==See Also==
*Tintinalli
*[[Abdominal Pain]]


[[Category:Surg]]
==References==
<references/>
[[Category:ID]]
[[Category:Surgery]]

Latest revision as of 11:25, 23 April 2022

Background

Psoas major and nearby muscles.
Horizontal disposition of the peritoneum in the lower part of the abdomen, showing psoas major.
  • Primary infection
    • Psoas muscle is susceptible to infection from distant sites due to rich blood supply, proximity to overlying retroperitoneal lymphatic channels
  • Secondary infection
    • Direct spread/extension via adjacent infection
    • S. aureus is most common pathogen (80%)

Clinical Features

Late finding of a large psoas abscess progressing to visible left buttock mass with erythematous skin eruption.
  • Abdominal pain radiating to hip, flank
  • Pain with thigh flexion (esp against resistance)
  • Limp
  • Fever
  • Nausea
  • Back pain[1]

Differential Diagnosis

Hip pain

Acute Trauma

Chronic/Atraumatic

RLQ Pain

LLQ Pain

Evaluation

Psoas muscle abscess on CT.
Psoas muscle abscess on CT.
(A) Abdominal computed tomography, revealing abscess formation on the left psoas muscle, which was depicted as a localized low density area. (B) Magnetic resonance imaging shows multiseptated psoas abscess and gluteal abscess.

Work Up[2]

  • Lab Studies
  1. CBC
  2. Chem-10
  3. Lactic
  4. Blood cultures
  • CT abdomen/pelvis with contrast (imaging study of choice)[3]
  • MRI has higher sensitivity (if available)[4]
  • Lower accuracy with US
  • MRI or US preferred in pregnant patients

Diagnosis

  • Typically on imaging

Management

See Also

References

  1. ↑ Dietrich A, Vaccarezza H, and Vaccaro CA. “Iliopsoas abscess: presentation, management, and outcomes,” Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, vol. 23, no. 1, pp. 45–48, 2013.
  2. ↑ Shields D, Robinson P, Crowley TP. “Iliopsoas abscess—a review and update on the literature,” International Journal of Surgery. 2012; 10(9): 466–469.
  3. ↑ Hosn S. Psoas muscle abscess. Radiology Reference Article. Radiopaedia.org. Radiopaediaorg. 2015. Available at: http://radiopaedia.org/articles/psoas-muscle-abscess. Accessed May 21, 2015.
  4. ↑ Hosn S. Psoas muscle abscess. Radiology Reference Article. Radiopaedia.org. Radiopaediaorg. 2015. Available at: http://radiopaedia.org/articles/psoas-muscle-abscess. Accessed May 21, 2015.
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