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it is an unusual clinical presentation of psoas abscess
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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