Psoas abscess
Updates to Case Attributes
The patient's presenting symptom was only severe "backback 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 mL of pus with ongoing antibiotics. Isolates of meticillin-resistant Staphylococcus aureus (MRSA) waswere demonstrated on the intraoperative specimen. A PET scan was performed for evaluation of the alternativeprimary 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.
-<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. Isolates of Staphylococcus aureus (MRSA) was demonstrated on the intraoperative specimen. 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>- +<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. Isolates of meticillin-resistant <em>Staphylococcus aureus </em>(MRSA) were demonstrated on the intraoperative specimen. A PET scan was performed for evaluation of the primary source of the abscess. It was concluded that the psoas abscess was the primary source.</p><p><a href="/articles/psoas-muscle-abscess" title="Psoas abscess">Psoas abscess</a> 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>
Updates to Study Attributes
On axial T2 and coronal STIR, there is a partially imaged right-sided hyperintense retro fascialretrofascial mass. This appears to encompass, encompassing and abutabutting the psoas major muscle. The mass appears to extend further inferiorly into the iliopsoas compartment and involves the quadratus lumborum muscle.
Sagittal T1 and T2 demonstrate hyperintensityWell-defined hyperintense areas in the posterior vertebral regionsbodies of T11, L3 and S1 on sagittal T1 and T2, these are likely vertebral haemangiomashemangiomas.
There is a normal enhancementNormal morphology and morphologyenhancement of the spinal cord. Normal thoracolumbar alignment. No appreciable bone marrow oedemaedema or infiltrates are appreciated.
In the context of the noted history of fever and back pain, the most likely differential of this partially imaged mass would be a psoas abscess. Recommend CT abdominal pelvis with contrast for further characterisationcharacterization.
Updates to Study Attributes
A large multiloculated right-sided hypodense collection extends antero-inferiorly from the psoas major and quadratus lumborum muscles into the inguinal region. Appreciable concomitant right-sided inguinal lymphadenopathy, likely reactive. Additional features of focal cellulitis around the right superficial femoralrectus femoris muscle.
Radiological findings combined with a clinical history of feversfever and back pain isare suggestive of a psoas abscess.