Psoas abscess: Difference between revisions
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*Psoas muscle is susceptible to infection from distant sites due to rich blood supply, proximity to overlying retroperitoneal lymphatic channels | *Psoas muscle is susceptible to infection from distant sites due to rich blood supply, proximity to overlying retroperitoneal lymphatic channels | ||
*S. aureus is most common pathogen (80%) | *S. aureus is most common pathogen (80%) | ||
==Clinical Features== | |||
*Abdominal pain radiating to hip, flank | |||
*Pain with thigh flexion (esp against resistance) | |||
*Limp | |||
*Fever | |||
*Nausea | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Diagnosis== | ==Diagnosis== | ||
*CT is imaging study of choice | *CT is imaging study of choice | ||
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*[[Abdominal Pain]] | *[[Abdominal Pain]] | ||
== | ==References== | ||
[[Category:ID]] | [[Category:ID]] | ||
[[Category:Surg]] | [[Category:Surg]] | ||
Revision as of 03:34, 7 June 2015
Background
- Psoas muscle is susceptible to infection from distant sites due to rich blood supply, proximity to overlying retroperitoneal lymphatic channels
- S. aureus is most common pathogen (80%)
Clinical Features
- Abdominal pain radiating to hip, flank
- Pain with thigh flexion (esp against resistance)
- Limp
- Fever
- Nausea
Differential Diagnosis
Hip pain
Acute Trauma
- Femur fracture
- Proximal
- Intracapsular
- Extracapsular
- Shaft
- Mid-shaft femur fracture (all subtrochanteric)
- Proximal
- Hip dislocation
- Pelvic fractures
Chronic/Atraumatic
- Hip bursitis
- Psoas abscess
- Piriformis syndrome
- Meralgia paresthetica
- Septic arthritis
- Obturator nerve entrapment
- Avascular necrosis of hip
RLQ Pain
- GI
- Appendicitis
- Perforated appendicitis
- Peritonitis
- Crohn's disease (terminal ileitis)
- Diverticulitis (cecal, Asian patients)
- Inguinal hernia
- Mesenteric ischemia
- Ischemic colitis
- Meckel's diverticulum
- Neutropenic enterocolitis (typhlitis)
- Appendicitis
- GU
- Other
LLQ Pain
- Diverticulitis
- Kidney stone
- UTI
- Pyelonephritis
- Ectopic pregnancy
- Infectious colitis
- Inflammatory bowel disease (Crohn's Disease, Ulcerative Colitis)
- Inguinal hernia
- Mesenteric ischemia
- Epiploic appendagitis
- Mittelschmerz
- Ovarian cyst
- Ovarian torsion
- PID
- Psoas abscess
- Testicular torsion
- Appendicitis
- Abdominal aortic aneurysm
- Herpes zoster
- Endometriosis
- Colon cancer
- Irritable bowel syndrome
- Small bowel obstruction
Diagnosis
- CT is imaging study of choice
Treatment
- Antibiotics
- Vancomycin +
- One of the following
- Piperacillin/tazobactam 3.375g, OR
- Ceftriaxone + Metronidazole
- Surgical consultation