Psoas abscess: Difference between revisions
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*S. aureus is most common pathogen (80%) | *S. aureus is most common pathogen (80%) | ||
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===Right=== | ===Right Lower Quadrant=== | ||
{{Abd DDX RLQ}} | {{Abd DDX RLQ}} | ||
===Left=== | ===Left Lower Quadrant=== | ||
{{Template:LLQ DDX}} | {{Template:LLQ DDX}} | ||
Revision as of 03:59, 27 October 2014
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%)
Differential Diagnosis
Right Lower Quadrant
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
Left Lower Quadrant
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
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
See Also
Source
- Tintinalli