Psoas Muscle Abscess

               An abnormal fluid collection in the psoas muscle region most often is an abscess, and less often a hematoma. In a setting of pancreatitis, a pseudocyst is also in the differential. A primary iliopsoas abscess is not common; a number of these occur in IV drug users and those positive for human immunodeficiency virus. More often these abscesses develop from a gastrointestinal, genitourinary, or spinal source. Some retroperitoneal abscesses involve not only the psoas muscles but also spread along soft tissue planes into adjacent compartments. Psoas abscesses develop in Crohn’s patients with disease.
               Gram stain and a culture of the abscess contents should establish the responsible organism. Blood cultures are less often helpful.Both grampositive and gram-negative organisms are involved. In some parts of the world a tuberculous psoas abscess is more common than a pyogenic abscess; a tuberculous abscess tends to involve the adjacent vertebrae. Tuberculous psoas abscesses can be successfully drained percutaneously, although abscess recurrence often requires repeat drainage. The clinical triad of fever, flank or thigh pain, and limitation of hip movement is found only in about half or fewer patients with a psoas abscess. Sepsis is common.
               Computed tomography readily detects psoas abscesses; however, differentiation from a tumor purely on CT criteria is problematic. A hematoma is also often in the differential. Image-guided needle aspiration should be diagnostic and percutaneous catheter drainage therapeutic. Magnetic resonance imaging is very useful in evaluating psoas muscles.Normal psoas muscle is hypointense on T2-weighted images, while abscesses and the occasional psoas muscle tumor are hyperintense.Contrast-enhanced MR of a psoas abscess reveals a signal void surrounded by intense enhancement.
              Conventional therapy of these abscesses is surgical drainage, although percutaneous drainage using CT or US guidance is becoming
more common. In distinction to intraabdominal abscesses, surgical psoas abscess drainage appears to result in a shorter patient hospitalization than with percutaneous drainage. On the other hand, serious complications are more common after surgical drainage than after percutaneous drainage. Imaging confirms abscess resolution. image
This is radiology images of the psoas abscess. Transverse CT image reveals an enlarged,mostly hypodense right psoas muscle (arrow) displacing kidney anterior.
Previous Post
Next Post

0 komentar: