Psoas abscess: Difference between revisions
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*S. aureus is most common pathogen (80%) | *S. aureus is most common pathogen (80%) | ||
==Clinical Features== | |||
*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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*Nausea | *Nausea | ||
== | ==Differential Diagnosis== | ||
{{Hip pain DDX}} | |||
{{Abd DDX RLQ}} | |||
{{Template:LLQ DDX}} | |||
==Evaluation== | |||
*CT is imaging study of choice | *CT is imaging study of choice | ||
== | ==Management== | ||
* | *[[Antibiotics]] | ||
**[[Vancomycin]] plus | |||
**[[Piperacillin/tazobactam]] 3.375g, '''OR''' | |||
**[[Ceftriaxone]] + [[Metronidazole]] | |||
*Surgical consultation | |||
==See Also== | |||
*[[Abdominal Pain]] | |||
==References== | |||
<references/> | |||
[[Category:ID]] | [[Category:ID]] | ||
[[Category: | [[Category:Surgery]] | ||
Revision as of 13:44, 11 August 2017
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
Evaluation
- CT is imaging study of choice
Management
- Antibiotics
- Vancomycin plus
- Piperacillin/tazobactam 3.375g, OR
- Ceftriaxone + Metronidazole
- Surgical consultation