Psoas muscle abscess

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
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Psoas muscle abscess
Synonyms	Iliopsoas abscess
Pronounce	N/A
Specialty	N/A
Symptoms	Fever, back pain, flank pain, limp
Complications	Sepsis, spread of infection
Onset	Gradual
Duration	Varies
Types	N/A
Causes	Bacterial infection, often Staphylococcus aureus
Risks	Diabetes mellitus, intravenous drug use, immunosuppression
Diagnosis	CT scan, MRI, ultrasound
Differential diagnosis	Herniated disc, pyelonephritis, appendicitis
Prevention	N/A
Treatment	Antibiotics, surgical drainage
Medication	Antibiotics such as vancomycin, ceftriaxone
Prognosis	Generally good with treatment
Frequency	Rare
Deaths	N/A

Psoas muscle abscess

A Psoas Muscle Abscess is a collection of pus in the psoas muscle, which is located in the lower lumbar region of the spine and extends through the pelvis to the femur. This condition can be classified into two types: primary and secondary. The primary abscess is a result of a blood-borne infection, whereas the secondary abscess is due to the direct extension of an infection from adjacent structures or a penetrating injury.

Causes

The primary psoas abscess is often caused by Staphylococcus aureus, and is more common in regions with a high incidence of tuberculosis. Secondary psoas abscesses are usually the result of conditions such as Crohn's disease, appendicitis, diverticulitis, and infections in the spine, known as vertebral osteomyelitis.

Symptoms

Common symptoms of a psoas muscle abscess include fever, back pain, and hip pain. Patients may also experience anorexia, weight loss, and a noticeable limp. The pain may radiate to the abdomen, thigh, or groin. Due to its deep location, the abscess can be difficult to detect physically, making imaging studies crucial for diagnosis.

Diagnosis

Diagnosis of a psoas muscle abscess typically involves a combination of medical history, physical examination, and imaging studies. Magnetic resonance imaging (MRI) and computed tomography (CT) scan are the most effective imaging techniques for identifying the abscess. Blood tests may also be conducted to identify the causative agent, especially in cases of primary abscess.

Treatment

Treatment for a psoas muscle abscess usually involves antibiotics to address the infection and drainage of the abscess. Drainage can be performed either percutaneously under imaging guidance or through open surgical intervention. The choice of treatment depends on the size of the abscess and the patient's overall condition. In cases of secondary abscess, treatment also focuses on addressing the underlying condition.

Prognosis

The prognosis for individuals with a psoas muscle abscess is generally good with timely and appropriate treatment. However, delays in diagnosis or treatment can lead to complications such as sepsis, which can be life-threatening.

Prevention

Prevention of a psoas muscle abscess primarily involves the prompt treatment of infections that could lead to the development of an abscess. In regions where tuberculosis is prevalent, measures to reduce the transmission of TB can also help prevent primary psoas abscesses.

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