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Psoas abscess

Patterson RAP - MedPix

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Psoas abscess

History: Patient presented to the ER in Jan2003 with 2 day history of fever, night sweats, groin pain, anorexia, nausea, and fatigue. Approximately 2 weeks prior to presentation the patient was seen by PCP for low-grade fevers and mild groin pain that radiated to her hip and back. She was diagnosed with groin strain and prescribed Flexeril. The patient continued to experience intermittent fevers and progressively worsening pain in her hip and groin despite frequent use of Flexeril. The pain was noted to be particularly bad while climbing stairs that would improve with sitting and rest. There were otherwise no changes in her bowel habits or stool quality (2-3 loose stools/day), no urinary symptoms, chest pain, dispnea, hemoptysis, or musculoskeletal trauma. The patient also denied a history of chronic gastrointestinal disease. She had an appendectomy 10 years ago. Past medical history also significant for a right sided nephrectomy in 2002 for an angiolipoma. Post-operative course complicated by a septic hematoma in the right kidney fossa, pneumonia and deep venous thromboses (DVTs). In 2003 an IVC Greenfield filter was placed for recurrent DVTs unresponsive to anticoagulation therapy. Medications Flexeril, Aygestin (for Menorrhagia), Progestin and Coumadin.

Findings: Frontal view of the abdomen shows an abnormal psoas shadow (i.e. blurring of the right psoas muscle edge). Axial images from CECT (IV and oral) of the abdomen and pelvis at L2 or L3 shows a rim enhanced low-attenuation mass in the right posterior abdomen in close proximity to the cecum laterally, extending medially into the psoas muscle. Additional axial images shows that the mass is fusiform and extends from approximately T12 into the pelvis along the psoas muscle.

Ddx: Abdominal plain film: retroperitoneal inflammatory process resulting in fluid or pus accumulation, retroperitoneal malignancy (primary or metastatic), hematoma CT with IV and oral contrast: Abscess (ruptured appendix/diverticulum, Crohn’s disease with fistula formation, chronic pyelonephritis, spreading infection from the spine), Neoplastic (locally invasive colon cancer/ renal cell carcinoma, metastatic cancer, lymphoma)

Exam: Patient was normotensive, tachycardic, and febrile. The abdomen was without rashes, distention, tenderness, masses, hepatosplenomegaly, guarding or rebound, and bowel sounds were present throughout. The right groin area was tender to mild palpation. The patient had tenderness with passive extension of right thigh (a positive psoas sign) and no tenderness with passive internal rotation of flexed thigh (negative obdurator sign). The physical exam was otherwise unremarkable. Labs: CBC: 20>12.1/36.5<350; basic metabolic panel: wnl; urinalysis abnormal for high amount of blood; stool guaiac negative

No MeSH data available.


There is a vena cava filter.   The right psoas margin appears indistinct - as compared to the left side.
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MPX1959_synpic20917: There is a vena cava filter. The right psoas margin appears indistinct - as compared to the left side.


Psoas abscess

Patterson RAP - MedPix

There is a vena cava filter.   The right psoas margin appears indistinct - as compared to the left side.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX1959&req=5

MPX1959_synpic20917: There is a vena cava filter. The right psoas margin appears indistinct - as compared to the left side.

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Psoas abscess

History: Patient presented to the ER in Jan2003 with 2 day history of fever, night sweats, groin pain, anorexia, nausea, and fatigue. Approximately 2 weeks prior to presentation the patient was seen by PCP for low-grade fevers and mild groin pain that radiated to her hip and back. She was diagnosed with groin strain and prescribed Flexeril. The patient continued to experience intermittent fevers and progressively worsening pain in her hip and groin despite frequent use of Flexeril. The pain was noted to be particularly bad while climbing stairs that would improve with sitting and rest. There were otherwise no changes in her bowel habits or stool quality (2-3 loose stools/day), no urinary symptoms, chest pain, dispnea, hemoptysis, or musculoskeletal trauma. The patient also denied a history of chronic gastrointestinal disease. She had an appendectomy 10 years ago. Past medical history also significant for a right sided nephrectomy in 2002 for an angiolipoma. Post-operative course complicated by a septic hematoma in the right kidney fossa, pneumonia and deep venous thromboses (DVTs). In 2003 an IVC Greenfield filter was placed for recurrent DVTs unresponsive to anticoagulation therapy. Medications Flexeril, Aygestin (for Menorrhagia), Progestin and Coumadin.

Findings: Frontal view of the abdomen shows an abnormal psoas shadow (i.e. blurring of the right psoas muscle edge). Axial images from CECT (IV and oral) of the abdomen and pelvis at L2 or L3 shows a rim enhanced low-attenuation mass in the right posterior abdomen in close proximity to the cecum laterally, extending medially into the psoas muscle. Additional axial images shows that the mass is fusiform and extends from approximately T12 into the pelvis along the psoas muscle.

Ddx: Abdominal plain film: retroperitoneal inflammatory process resulting in fluid or pus accumulation, retroperitoneal malignancy (primary or metastatic), hematoma CT with IV and oral contrast: Abscess (ruptured appendix/diverticulum, Crohn’s disease with fistula formation, chronic pyelonephritis, spreading infection from the spine), Neoplastic (locally invasive colon cancer/ renal cell carcinoma, metastatic cancer, lymphoma)

Exam: Patient was normotensive, tachycardic, and febrile. The abdomen was without rashes, distention, tenderness, masses, hepatosplenomegaly, guarding or rebound, and bowel sounds were present throughout. The right groin area was tender to mild palpation. The patient had tenderness with passive extension of right thigh (a positive psoas sign) and no tenderness with passive internal rotation of flexed thigh (negative obdurator sign). The physical exam was otherwise unremarkable. Labs: CBC: 20>12.1/36.5<350; basic metabolic panel: wnl; urinalysis abnormal for high amount of blood; stool guaiac negative

No MeSH data available.