A 45-year old diabetic patient in ICU with end-stage renal disease referred for evaluation of persistent fever and abdominal pain. History of left side nephrectomy 10 years earlier.
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Unenhanced CT scan revealed a large thick walled abscess within the left psoas muscle.
There is also left superior lumbar hernia as well.
1 case question available
Findings are in keeping with left psoas muscle abscess. Left superior lumbar hernia is an incidental finding in this patient.
It is often necessary for psoas abscesses to be drained and they are usually amenable to CT guided percutaneous drainage, with the patient in the prone position. On occasion, ultrasound-guided percutaneous abscess drainage is also undertaken.
An important differential is a spontaneous psoas haematoma and tumour, such as a sarcoma, although the clinical scenario may help assist in distinguishing. Another important consideration is the primary pathology may be a haematoma that becomes secondarily infected.
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- 2. Van Dyke JA, Holley HC, Anderson SD. Review of iliopsoas anatomy and pathology. Radiographics. 1987;7 (1): 53-84. Radiographics (abstract) - Pubmed citation