A abscess. They occur more often in males than

A psoas
abscess is a collection of pus in the iliopsoas group of muscles. It has an
insidious onset and the incidence is rare, but it can be a significant cause of
morbidity and mortality without proper treatment.  Psoas abscesses can be divided into primary
and secondary abscesses. Primary abscesses occur as a result of hematogenous or
lymphatic spread from trauma or a chronic condition. IV drug use, HIV/AIDS,
diabetes, renal failure and immunosuppression are all factors for primary
abscess formation. Younger age groups are more often affected, especially in
developing or tropical countries. Secondary psoas abscesses occur as a result
of direct spread from structures adjacent to the psoas muscle.  The most common cause of this is Crohn’s
disease, but other causes include GI or GU infections, vertebral osteomyelitis,
colorectal or GU cancer, and infected abdominal aortic aneurysm. Surgeries and
procedures around the psoas muscle can also introduce abscess forming
pathogens.

            Psoas abscesses are usually due to a single organism,
with the most common being Staphylococcus aureus, including MRSA. Studies have
shown 88% of psoas abscesses are related to S. aureus infections. In developing
countries where TB is still prevalent, Mycobacterium tuberculosis is still a
common cause of a psoas abscess. They occur more often in males than females,
and the typical age range is the 4th and 5th decade. In
developing countries, there is still a high prevalence in the adolescent
population. Psoas abscesses occur with the same frequency on both the right and
left sides of the body, but bilateral occurrence is rare. The clinical
presentation of a psoas abscess can vary, but usually includes flank pain,
fever, and limp. Pain may radiate down the back to the thighs, and general
symptoms can include malaise, nausea, and weight loss. Back pain may be
exacerbated by extending the hip (psoas sign); patients prefer to keep the hip
flexed to lessen pain and discomfort. As the symptoms may be non-specific, a
psoas abscess may be misdiagnosed, leading to delay in treatment and a
worsening prognosis. Lab tests are also non-specific, with the most common
finding being a high WBC count or elevated CRP/ESR. Complications of a psoas
abscess include septic shock, deep venous thrombosis from compression of the
femoral vein, or hydronephrosis from ureteric obstruction.

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            CT imaging is considered the gold standard for diagnosing
a psoas abscess. MRI is also effective for visualization of the soft tissues in
the area. Ultrasound is cheaper and more widely available, but it is diagnostic
in only about 60% of cases as the abscess can be obscured by bowel gas. Blood
cultures can also help find the causative organism for treatment decisions.

Treatment consists of antibiotic therapy and incision and drainage of the
abscess. In patients such as this one with suspected primary abscesses,
empirical therapy should be started even before the results of the culture.

Percutaneous drainage is usually the preferred method of draining the abscess,
and a pigtail catheter is left in place until the patient’s condition has improved
and the drainage has ceased. Proper length of treatment is required to prevent
recurrence of the abscess, not to mention lowering associated morbidity and
mortality. 

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