Psoas abscess
Updates to Study Attributes
A large multiloculated right-sided hypodense collection extends antero-inferiorly from the psoas major and quadratus lumborum into the inguinal region. Appreciable concomitant right-sided inguinal lymphadenopathy, likely reactive. Additional features of focal cellulitis around the right superficial femoral muscle.
The kidneys and bladder are unremarkable. The small and large bowels have normal calibre and enhancement.The liver is unremarkable on the portal venous phase.
Large, low-density collection in the right psoas extending inferior to the iliopsoas muscleRadiological findings combined with a clinical history of fevers and back pain is suggestive of ana psoas abscess. Consultation with interventional radiology is recommended in the first instance.
Updates to Study Attributes
On axial T2 and coronal STIR, there is a partially imaged right-sided hyperintense retro fascial mass. This appears to encompass and abut the psoas major. The mass appears to extend further inferiorly into the iliopsoas compartment and involves the quadratus lumborum.
Sagittal T1 and T2 demonstrate hyperintensity in the posterior vertebral regions of T11, L3 and S1, these are likely vertebral haemangiomas.
There is a normal enhancement and morphology of the spinal cord. Normal thoracolumbar alignment. No appreciable bone marrow oedema or infiltrates are appreciated.
In the context of the noted history of fever and back pain, the differential of this partially imaged mass would be a psoas abscess. Recommend CT abdominal pelvis with contrast for further characterisation.
Updates to Case Attributes
The patient's presenting symptom was only severe "back pain" and right thigh/hip pain. The patient later developed a fever 48 hours after admission, for what was originally suspected to be radicular back pain. MRI was initially performed to evaluate for potential osteomyelitis, which was later discovered to be a psoas abscess.
The patient subsequently had an uncomplicated interventional radiology drainage of over 600 mlmL of pus with ongoing antibiotics. A PET scan was performed for evaluation of the alternative source of the abscess. It was concluded that the psoas abscess was the primary source.
Psoas abscess is a life-threatening diagnosis, requiring prompt treatment with antibiotics and consideration of drainage. Features of a psoas abscess on CT often include diffuse enlargement of the psoas muscle with an area of central low density. CT is the mainstay of the diagnosis, however, in this patient, it was incidentally detected on MRI.
-<p>The patient's presenting symptom was only severe "back pain" and right thigh/hip pain. The patient later developed a fever 48 hours after admission, for what was originally suspected to be radicular back pain. MRI was initially performed to evaluate for potential osteomyelitis, which was later discovered to be a psoas abscess.</p><p>The patient subsequently had an uncomplicated interventional radiology drainage of over 600 ml of pus with ongoing antibiotics. A PET scan was performed for evaluation of the alternative source of the abscess. It was concluded that the psoas abscess was the primary source.</p><p>Psoas abscess is a life-threatening diagnosis, requiring prompt treatment with antibiotics and consideration of drainage. Features of a psoas abscess on CT often include diffuse enlargement of the psoas muscle with an area of central low density. CT is the mainstay of the diagnosis, however, in this patient, it was incidentally detected on MRI.</p>- +<p>The patient's presenting symptom was only severe "back pain" and right thigh/hip pain. The patient later developed a fever 48 hours after admission, for what was originally suspected to be radicular back pain. MRI was initially performed to evaluate for potential osteomyelitis, which was later discovered to be a psoas abscess.</p><p>The patient subsequently had an uncomplicated interventional radiology drainage of over 600 mL of pus with ongoing antibiotics. A PET scan was performed for evaluation of the alternative source of the abscess. It was concluded that the psoas abscess was the primary source.</p><p>Psoas abscess is a life-threatening diagnosis, requiring prompt treatment with antibiotics and consideration of drainage. Features of a psoas abscess on CT often include diffuse enlargement of the psoas muscle with an area of central low density. </p>