Psoas abscess
Background
- 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
- 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
- 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
Work Up[2]
- Lab Studies
- CBC
- Chem-10
- Lactic
- 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
- Antibiotics
- Vancomycin plus
- Piperacillin/tazobactam 3.375g, OR
- Ceftriaxone + Metronidazole
- Ultimate treatment is surgical drainage: Surgery or IR consultation
See Also
References
- ↑ 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.
- ↑ Shields D, Robinson P, Crowley TP. “Iliopsoas abscess—a review and update on the literature,” International Journal of Surgery. 2012; 10(9): 466–469.
- ↑ 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.
- ↑ 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.