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Mentions: One week after he was admitted to the hospital, the patient became febrile to >39°C. Ultrasound revealed a bulky, non-uniform hypoechoic mass anterior to the left hip, which extended intra-abdominally up to the iliac fossa, and to the position of the psoas muscle. CT and MRI of the abdomen and pelvis revealed a large lesion with abnormal signal intensities in the left psoas muscle (Figure 1). MRI and emission computerized tomography (ECT) excluded spondylodiscitis and osteomyelitis. Ultrasound guided percutaneous drainage yielded 300 ml of pus from the psoas muscle; culture of this material detected Staphylococcus aureus. Blood culture was negative.
Primary psoas abscess extending to thigh adductors: case report
Bottom Line: Delayed diagnosis can result in poor prognosis.Follow-up CT confirmed complete resolution of the abscess.Appropriate treatment includes open surgical drainage along with antibiotic therapy.
Affiliation: Department of Orthopaedics, West China Hospital, Sichuan University, Guoxue road, Chengdu, China.
Background: Psoas abscess is a rare condition consisting of pyomyositis of the psoas. The worldwide incidence was 12 cases per 100,000 per year in 1992, but the current incidence is unknown. Psoas abscess can descend along the psoas sheath and reach the inner upper third of the thigh, but only infrequently does it penetrate the sheath and involve the thigh adductors. Because of insidious clinical presentation, the diagnosis of psoas abscess is a challenge. Delayed diagnosis can result in poor prognosis.
Case presentation: A 45-year-old male with no significant past medical history presented with pain in the left thigh, and limitation of movement at the left hip and knee joint for one month. Ultrasound, CT, and MRI revealed a liquid mass in the left psoas. Percutaneous drainage of this mass yielded 300 ml pus from the psoas. After surgery, the patient reported relief of pain; however, ten days after removal of the drainage tube, the patient complained of persistent pain in his left thigh. CT revealed that the psoas abscess had extended inferiorly, and involved the entire set of adductors of the left thigh. Open surgical drainage was performed at the flank and at the thigh, yielding 350 ml of pus from the thigh. After open drainage and adequate antibiotic therapy, the patient made a good recovery. Follow-up CT confirmed complete resolution of the abscess.
Conclusions: Large psoas abscess can penetrate the psoas sheath, and descend to thigh adductors even after percutaneous drainage. Appropriate treatment includes open surgical drainage along with antibiotic therapy.
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