1/51. Pneumococcal psoas abscess.A 47-year-old woman was admitted to our hospital because of severe low back pain. A computed tomography (CT) scan revealed a left sided psoas muscle abscess. On the first hospital day, US-guided drainage was performed. streptococcus pneumoniae was isolated from the pus. Thereafter, the open drainage of the abscess and antibiotic treatment were given with subsequent clinical improvement. Only 10 cases of pneumococcal psoas abscess have been previously reported in the world literature.- - - - - - - - - - ranking = 1keywords = back pain, pain (Clic here for more details about this article) |
2/51. psoas abscess complicating Crohn's disease: report of a case.We describe herein the case of a psoas abscess complicating Crohn's disease, and present a review of the literature on this unusual disease entity. A 22-year-old Japanese man with a 5-year history of Crohn's ileocolitis presented with right lower abdominal and hip pain, and a diagnosis of right psoas abscess was subsequently made by abdominal computed tomography (CT). Following the administration of antibiotics and CT-guided percutaneous drainage of the abscess, the patient's symptoms temporarily improved; however, 2 weeks later, the abscess cavity was found to have extended around the periarticular tissue of the right hip joint. To prevent the development of septic arthritis of the hip joint, surgical drainage of the abscess cavity and ileocecal resection were immediately performed, after which the patient's condition greatly improved. The resected specimen showed Crohn's ileocolitis with an external fistula in the terminal ileum which was considered to have caused the psoas abscess. Since psoas abscess in Crohn's disease can result in serious complications such as septic arthritis of the hip joint if left untreated, aggressive treatment should be initiated without delay.- - - - - - - - - - ranking = 0.039172054644703keywords = pain (Clic here for more details about this article) |
3/51. Unilateral psoas abscess following posterior transpedicular stabilization of the lumbar spine.A case of unilateral psoas abscess in a 58-year-old patient, shortly after posterior lower spine stabilization and fusion for spinal stenosis using transpedicular spine fixation is reported. The diagnosis was delayed because the patient's symptoms were referred to the thigh and the plain roentgenograms were negative for pathology. The technetium scintigram and computed tomography (CT) helped localization, diagnosis and treatment of the psoas abscess. Percutaneous CT-guided drainage was followed by recurrence of the abscess, and open surgical evacuation was performed successfully in combination with antibiotic treatment for 8 weeks. psoas abscess should always be suspected when recurrent pain is associated with fever and elevated erythrocyte sedimentation rate after instrumentation of the lumbar spine. Hardware of a low profile and volume should be used to decrease dead space in the fusion area, and the volume of bone substitutes should be limited for the same reason.- - - - - - - - - - ranking = 0.039172054644703keywords = pain (Clic here for more details about this article) |
4/51. psoas abscess and cellulitis of the right gluteal region resulting from carcinoma of the cecum.Although retroperitoneal or psoas abscess is an unusual clinical problem, the insidious and occult characteristics of this abscess sometimes cause diagnostic delays, resulting in considerably high morbidity and mortality. In particular, psoas abscess caused by perforated colon carcinoma is uncommon. We report a case of psoas abscess caused by a carcinoma of the cecum. A 72-year-old Japanese woman was admitted to our hospital, with pain in the right groin and buttock. The pain had appeared 6 months before admission, and the symptoms had then been relieved by oral antibiotics. On March 25, 1999, inflammatory signs in the right buttock indicated localized cellulitis, and incision and drainage was performed at a local hospital. The patient was referred to our hospital on the same day. On admission to our hospital, computed tomography (CT) scan revealed a thick right-sided colonic wall and enlargement of the right ileopsoas muscle. barium enema and colonofiberscopy revealed an ulcerated tumor occupying the entire circumference of the cecum. A retroperitoneal abscess and fistula had been formed by the retroperitoneal perforation of cecum carcinoma: surgical resection was performed after remission of the local inflammatory signs. Operative findings indicated that the cancerous lesion and its surrounding tissues were firmly attached to the right iliopsoas and major psoas muscle, and en-bloc resection, including adjacent muscular tissue, was performed. The fact that carcinoma of the colon could be a cause of psoas abscess and cellulitis in the gluteal region should be considered when an unexplained psoas abscess is diagnosed.- - - - - - - - - - ranking = 0.078344109289406keywords = pain (Clic here for more details about this article) |
5/51. Differentiation of psoas muscle abscess from septic arthritis of the hip in children.A 20-year review was conducted of children presenting with psoas abscess at two major pediatric hospitals. Eleven children with psoas abscesses were identified. The extreme variability in the clinical presentation of this condition is shown. psoas abscess was most difficult to differentiate from septic arthritis of the hip in pediatric patients. This study also shows the often circuitous investigative route traversed before arriving at the diagnosis of psoas abscess. Atypical features, such as femoral nerve neurapraxia or bladder irritability in association with hip pain, should alert the clinician to consider psoas abscess. Based on this study, a diagnostic algorithm to differentiate between psoas abscess and septic hip was formulated.- - - - - - - - - - ranking = 0.039172054644703keywords = pain (Clic here for more details about this article) |
6/51. klebsiella pneumoniae psoas abscess: predominance in diabetic patients and grave prognosis in gas-forming cases.Seven cases of psoas abscess caused by klebsiella pneumoniae were observed at the National Cheng Kung University Hospital within a period of 4.5 years. These cases constituted 25% of a total 28 episodes of non-tuberculous psoas abscess, ranking second to those caused by staphylococcus aureus (8 cases). Eight cases of psoas abscess caused by K. pneumoniae were identified from medline, and 5 of which were reported from taiwan. Of these 8 cases, 1 neonatal case was excluded, and the remaining 7 adult cases were combined with the 7 cases in this series for analysis. The mean age was 53.8 years, and diabetes mellitus was the most common underlying disease. fever and pain on the flank and back area were the common findings. The interval between the onset of symptoms and diagnosis ranged from 1 to 60 days. The most common sites of concurrent infection were the urinary tract (6 cases; 43%) and bone (3 cases; 21%). All patients received percutaneous or surgical drainage in addition to antibiotic treatment. Gas formation was present in 5 of the 12 patients recorded, and 4 of them died during hospitalization. Only 1 patient had a metastatic infection with osteomyelitis of the left radius and right humerus; he had experienced 5 episodes of recurrent K. pneumoniae infections in different sites. We concluded that K. pneumoniae should be considered as an important endemic pathogen of psoas abscess in diabetics in taiwan. The high mortality rate in the gas-forming cases should also be highlighted. Early recognition, empiric antimicrobial coverage for K. pneumoniae, and aggressive drainage or debridement are indicated in these patients.- - - - - - - - - - ranking = 0.039172054644703keywords = pain (Clic here for more details about this article) |
7/51. Unusual presentation of psoas abscess in a child.Primary abscess of the psoas muscle is relatively rare in infants and young children. The clinical presentation of the disease, with limping, fever, and abdominal pain, may be confused with conditions such as septic arthritis of the hip, osteomyelitis, or appendicitis. The authors present an unusual case of a ruptured left psoas abscess presenting as generalized peritonitis in a child. J Pediatr Surg 36:1859-1860.- - - - - - - - - - ranking = 0.039172054644703keywords = pain (Clic here for more details about this article) |
8/51. psoas abscess associated with infected total hip arthroplasty.A 65-year-old man with a left uncemented total hip arthroplasty performed 11 years previously was admitted with a history of progressive low back pain, left hip pain, and sepsis that had begun 6 months earlier. On physical examination, a gross, fluctuant mass was palpated in the left thigh. A computed tomography (CT) scan revealed a 6.5 x 3 cm left retrofascial psoas abscess communicating with the hip joint. The patient underwent irrigation and debridement of the hip with removal of the components. The psoas abscess was drained through the iliopsoas bursa. A residual psoas abscess was drained percutaneously under CT guidance. Cultures isolated escherichia coli, and the patient responded to 6 months of ciprofloxacin therapy. After 1 year, the patient had no evidence of infection. Pathways of infection spread, diagnosis, and treatment of a patient with this rare association are discussed with a review of the literature.- - - - - - - - - - ranking = 1.0391720546447keywords = back pain, pain (Clic here for more details about this article) |
9/51. Vertebral osteomyelitis and psoas abscess occurring after obstetric epidural anesthesia.BACKGROUND AND OBJECTIVES: Back pain and infectious complications occasionally occur after epidural anesthesia in obstetrics, and accurate diagnosis can be difficult. We report a patient who developed low back pain soon after obstetric epidural anesthesia and was diagnosed 6 months later with lumbar vertebral osteomyelitis, discitis, and a psoas abscess. CASE REPORT: A 34-year-old woman developed persistent low back pain after receiving epidural anesthesia for labor analgesia and cesarean delivery. After 6 months, a diagnosis of lumbar vertebral osteomyelitis, discitis, and psoas abscess was made, and surgery was performed. Because of the temporal and anatomical relationships between epidural catheterization and the development of symptoms, the preceding epidural anesthesia was initially suspected as a potential cause. However, because the posterior spinal elements were unaffected and the infectious agent was subsequently identified as tuberculous, the cause was eventually determined as unlikely to be related to the epidural procedure. CONCLUSION: Investigation of severe back pain after epidural anesthesia should include consideration of infectious causes, such as vertebral osteomyelitis and discitis, which may not be causally related to the epidural catheterization itself.- - - - - - - - - - ranking = 3.0391720546447keywords = back pain, pain (Clic here for more details about this article) |
10/51. Primary psoas abscess complicating a normal vaginal delivery.BACKGROUND: psoas abscess is a rare and potentially dangerous complication of normal delivery. CASE: We describe a case of primary psoas abscess after normal vaginal delivery. A young woman presented with fever, left back pain, left lower abdominal pain, and hip pain starting on postpartum day 2. Computed tomography demonstrated a large retroperitoneal collection. Aspiration drainage of the abscess under computed tomography guidance isolated Streptococcus viridans, which responded to antibiotic therapy and percutaneous drainage with complete resolution. CONCLUSION:A high index of suspicion is necessary for diagnosis of psoas abscess, which should be considered in postpartum patients with pyrexia, back and hip pain, and a normal neurologic examination. Computed tomography is effective for diagnosis and allows percutaneous drainage of the abscess.- - - - - - - - - - ranking = 1.1175161639341keywords = back pain, pain (Clic here for more details about this article) |
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