Psoas abscess

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%)

DDX

• Abdominal Pain#RLQ
• Abdominal Pain#LLQ

Diagnosis

Clinical Features

• Abdominal pain radiating to hip, flank
• Pain with thigh flexion (esp against resistance)
• Limp
• Fever
• Nausea

Workup

• CT is imaging study of choice

Treatment

• Antibiotics
  • Vancomycin +
  • One of the following
    • Piperacillin/tazobactam 3.375g, OR
    • Ceftriaxone + Metronidazole
• Surgical consultation

Source

• Tintinalli