P Laguna1, M Moya. 1. Departamento de Medicina, Hospital Puerta de Hierro, Universidad Autónoma de Madrid.
Abstract
BACKGROUND: Abscess of the psoas muscle (AP) is an infrequent disease of difficult diagnosis, developing spontaneously (primary AP) or by extension of a subjacent infection (secondary AP). In recent years changes have been observed in its etiology, advances in its diagnosis and modifications in the treatment schedules. METHODS: The cases of AP diagnosed from 1983-1996 were retrospectively studied. RESULTS: The cases included 11 AP, 5 (45%) primary and 6 (55%) secondary, of which the source of origin were: spondylitis in four, sacroiliac arthritis in one and intestinal in another. The clinical presentation was characterized by its prolonged course (evolution of symptoms greater than 30 days in 64% of the cases), with the most frequent symptoms being flank/abdominal pain (82%) and hip/inguinal pain (45%), with fever being presented in only 36%. The diagnostic profitability of echography and computerized tomography (CT) were 57% (4/7) and 91% (10/11), respectively. One case was diagnosed with magnetic resonance. The causal microorganisms were: Mycobacterium tuberculosis (36% of the cases), Staphylococcus aureus (18%), polymicrobian flora (18%) and Salmonella enteritidis, Streptococcus intermedius and Escherichia coli in 9% each. Eight cases (73%) underwent percutaneous (5 cases) and surgical (3 cases) drainage, with the evolution being favorable in 10 (91%) and death in one despite adequate medicosurgical treatment. CONCLUSIONS: The clinical presentation of AP is often unspecific, thereby delaying its diagnosis, and thus, CT is the procedure of choice. The tuberculous etiology continues to be frequent in our environment. Ultrasonographic or CT guided percutaneous drainage is a valid therapeutic alternative versus surgery.
BACKGROUND: Abscess of the psoas muscle (AP) is an infrequent disease of difficult diagnosis, developing spontaneously (primary AP) or by extension of a subjacent infection (secondary AP). In recent years changes have been observed in its etiology, advances in its diagnosis and modifications in the treatment schedules. METHODS: The cases of AP diagnosed from 1983-1996 were retrospectively studied. RESULTS: The cases included 11 AP, 5 (45%) primary and 6 (55%) secondary, of which the source of origin were: spondylitis in four, sacroiliac arthritis in one and intestinal in another. The clinical presentation was characterized by its prolonged course (evolution of symptoms greater than 30 days in 64% of the cases), with the most frequent symptoms being flank/abdominal pain (82%) and hip/inguinal pain (45%), with fever being presented in only 36%. The diagnostic profitability of echography and computerized tomography (CT) were 57% (4/7) and 91% (10/11), respectively. One case was diagnosed with magnetic resonance. The causal microorganisms were: Mycobacterium tuberculosis (36% of the cases), Staphylococcus aureus (18%), polymicrobian flora (18%) and Salmonella enteritidis, Streptococcus intermedius and Escherichia coli in 9% each. Eight cases (73%) underwent percutaneous (5 cases) and surgical (3 cases) drainage, with the evolution being favorable in 10 (91%) and death in one despite adequate medicosurgical treatment. CONCLUSIONS: The clinical presentation of AP is often unspecific, thereby delaying its diagnosis, and thus, CT is the procedure of choice. The tuberculous etiology continues to be frequent in our environment. Ultrasonographic or CT guided percutaneous drainage is a valid therapeutic alternative versus surgery.
Authors: J Heyd; R Meallem; Y Schlesinger; B Rudensky; I Hadas-Halpern; A M Yinnon; D Raveh Journal: Eur J Clin Microbiol Infect Dis Date: 2003-11-11 Impact factor: 3.267