Iliacus and groin abscess after intravenous drug use

Case contributed by Dr Mohamed Mahmoud Elthokapy

Presentation

History of IV use into the groin presented with right groin and iliac fossa pain, swelling, and fever.

Patient Data

Age: 20 years
Gender: Male

Diffuse enlargement and heterogeneous density of the right iliacus muscle showing heterogenous internal fluid locule with subtle marginal enhancement and blurred surrounding fat planes.

Right iliofemoral vessels are displaced anteriorly with the lower femoral vein that is partially opacified suggesting partial thrombosis (DVT). 

Slightly prominent reactive right inguinal lymph nodes.

Intact right iliac bone and hip joint with no evidence of bone destruction.  

Case Discussion

Aspiration was performed and revealed abundant pus clotted blood as well as inflammatory cells due to abscess formation.

The complications of intravenous drug use may involve the soft tissues,  skeleton, and vascular spaces.  When a mass is palpated in the groin in such a patient, duplex Doppler sonography is suggested as the initial imaging procedure. If a flow is demonstrated, the patient may proceed to angiography, if additional information is desired, or directly to surgery.

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