Iliopsoas abscess

Case contributed by Dr Saeed Soltany Hosn

Presentation

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.

Patient Data

Age: 45-year
Gender: Female
Modality: CT

Unenhanced CT scan revealed a large thick walled abscess within the left psoas muscle.

There is also left superior lumbar hernia as well.

Case Discussion

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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Case Information

rID: 21394
Case created: 20th Jan 2013
Last edited: 15th Feb 2016
Inclusion in quiz mode: Included

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