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Psoas muscle abscess

Psoas muscle abscess and fluid collections are located in the retrofascial space rather than in the retroperitoneal space because the psoas muscles are located in the iliopsoas compartment posterior to the transversalis fascia, which is the posterior boundary of the retroperitoneum.

Clinical presentation

Psoas muscle abscess may present with fever, flank pain, abdominal pain or limp. Other symptoms are nausea, malaise and weight loss.

Pathology

Psoas muscle abscess may be classified as primary or secondary depending on the presence or absence of underlying disease.

Primary

Primary psoas muscle abscess occurs probably as a result of haematogenous spread of an infectious process from an occult source in the body. Primary psoas muscle abscess can occur in patients with:

Secondary

Spread of infection from gastrointestinal disease (e.g. appendicitis, diverticulitis, Crohn's disease or perforated colon carcinoma) is the most common source of a
secondary psoas muscle fluid collection. 

Renal disease is the second most common source.

They may also occur as a result of a neighbouring spondylodiscitis.

Radiographic features

CT is the method of choice for abscess detection. 

Ultrasonography is diagnostic in only 60% of cases of psoas abscess, compared with 80% to 100% for CT. 

MRI also is helpful.

Treatment and prognosis

Appropriate antibiotics along with drainage of the abscess is the treatment of choice. This is often treated with a image guided percutaneous drainage, typically CT, due to the retroperitoneal location.

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