Unusual presentation of psoas abscess _a case

UNUSUAL PRESENTATION OF PSOAS ABSCESS_A

CASE

BY: Dr. Rekha Khare

MD RADIOLOGY

UNUSUAL PRESENTATION OF PSOAS ABSCESS_A CASE

A young man 37yr painter by occupation came to medical out patient department with painful lump in left flank for about two months. There was history of low grade pyrexia and constitutional symptoms

PHYSICAL EXAMINATION

Tender lump palpable in left renal fossa

No significant hip flexion deformity

LABORATORY FINDING

Raised white blood count

Raised C-reactive protein

ULTRASOUND FINDINGS

Thick walled complex echo mass in left renal fossa not connected to left kidney

Slightly thick psoas muscle with no fluid

B/L renal/ureteric calculi with hydronephrosis

Moderate Hepatosplenomegaly

CONTRAST CT SCAN FINDINGS

CT was done after 3 days of u/s exam Bulky left psoas muscle with collection in

muscular plane

Left psoas breaking anterio-superiorly in to a well enhanced huge thick walled multi- loculated pocket

Extension was noted laterally in superficial abdominal wall

Tiny abscess was also seen in left paraspinal region

CECT FINDINGS CONTD.

Left sided bowels displaced medially

B/L renal/ureteric calculi with moderate hydronephrosis

Moderate hepatosplenomegaly

CLINICO-RADIOLOGICAL DIAGNOSIS

Left chronic psoas abscess (ruptured/ extension extraperitoneal)

B/L hydronephrosis ( Rt ureteric and left renal calculus)

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MANAGEMENT……

Surgical drainage was done

Broad spectrum antibiotics given

Later on Anti tubercular treatment when AAFB was found +ve in pus

WHY CASE WAS UNUSUAL?

Case came for painful lump left abdomen

Clinically no hip flexion, an important sign in favor of psoas abscess

Initial U/S showed no communication between lump and psoas muscle

CONCLUDING POINTS……….

Sometimes it is difficult to identify psoas abscess on first visit

Repeated appropriate imaging should be considered if initial imaging is not compatible with clinical presentation

Microbiology of psoas abscess varies with geography. In endemic area abscess may be secondary to Mycobactrium Tuberculosis

REFERENCES…… Unusual presentation of psoas abscess

in a child. J pediatr surg. 2001Dec.36(12)1859-60 Ixheimer O. Cohen Z. Barki Y. Marks A. J

Case report: Psoas abscess- unusual etiology of Groin pain Med Gen Med. 2005,7(3):10Manoj Todkar

REFERENCES CONTD……

An unusual case of a psoas abscess. Irshad W. Gupta S. Katz A Deptt of Medicine ohn H Stroger Jr Hospital of Cook County Chicago