| 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. ( info) |
| psoas abscess is an uncommon condition with vague clinical presentation. It generally has an insidious onset and before the advent of computed tomography, few cases were reported in the medical literature. We report the case of a middle aged diabetic woman who presented with left leg swelling. Doppler ultrasound revealed thrombosis of the popliteal vein and a collection in the left groin. Computed tomography confirmed the presence of a large left iliopsoas abscess extending to the anterior compartment of the thigh complicated with thrombosis of the superficial femoral and popliteal veins. We suggest that an iliopsoas abscess should be excluded when an immunocompromised patient presents with deep vein thrombosis. ( info) |
33/180. Successful medical management of multifocal psoas abscess following cesarean section: report of a case and review of the literature. The psoas abscess is a rare complication in obstetric and gynaecology. Two types of psoas abscess are recognized. The primary psoas abscess is generally following haematogenous dissemination of an infectious agent and the source is usually occult. The most frequently isolated pathogen is staphylococcus aureus. On the other hand, the secondary abscess is the result of local extension of an infectious process near the psoas muscle. We report the case of a patient who develops a bacteremia from an infected cesarean section wound. The complications were thigh and psoas abscesses with left sacroiliitis. Medical management with prolonged antibiotherapy permit clinical, biological and radiological improvement. Although it required a long hospital stay, medical treatment alone was effective. More experience is required to determine which therapeutic option: medical treatment and/or surgery, is the best choice for this type of complication. ( info) |
34/180. 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. ( info) |
35/180. Clinics in diagnostic imaging (71). Left iliopsoas abscess secondary to vertebral osteomyelitis. A 26-year-old woman presented with a progressively painful lump at her left groin and upper thigh for five months. She also had intermittent back pain for three years. Radiographs and CT showed osteolytic destruction of the several contiguous thoracolumbar vertebrae with a large left iliopsoas abscess that extended to involve the left gluteus maximus and adductor magnus muscles. She responded well to a course of antibiotics.The role of imaging and imaging features of iliopsoas abscesses are discussed, together ( info) |
36/180. Relapsing hydatid disease involving the vertebral body and paravertebral soft tissues. Hydatid disease involving the vertebral body and paravertebral soft tissues is rare even in rural areas where echinococcosis is endemic. We report a case with hydatid disease in the T11-L1 vertebral bodies and involvement in bilateral psoas muscles. ( info) |
37/180. psoas abscess as the initial presentation of bladder cancer. A 43-year-old man presented with left leg pain and an abdominal mass. Sonography and cystoscopy showed a bladder tumour obstructing the left ureteral orifice. The left kidney became nonfunctional. Computerized tomography suggested psoas abscess. nephrectomy was done. Tumoral cells identified at cytological examination of psoas abscess but they were not found in the pyonephrotic kidney's pus. The patient declined further therapy and died 3 months postoperatively. This is the first case of bladder cancer presenting initially with psoas abscess. ( info) |
| We report a rare case of dual infection in a psoas abscess. Pus from the abscess grew salmonella typhi and the abscess wall showed epitheloid granulomas giant cells, which we confirmed as tuberculosis by PCR. Such dual infection cases may be missed unless looked for since both these infections are common in our country. ( info) |
39/180. Primary psoas abscess. Report of three cases. BACKGROUND: Primary psoas abscesses are a rare clinical entity with subtle and non specific symptoms, most commonly seen in patients predisposed to infections. early diagnosis and appropriate management are therefore challenging aspects for physicians. patients AND methods: We present three patients with primary pyogenic psoas abscess, treated at the Heraklion University Hospital, during a 5-year period. The two male and one female patient, aged 36-51 years were admitted with fever, abdominal pain and a palpable tender mass. RESULTS: The classical sign of limping was absent in all cases. Positive psoas symptoms were detected in only two patients. CT scan accurately confirmed the diagnosis in all cases. The patients were successfully treated with antibiotics and prolonged surgical drainage. staphylococcus aureus was the causative microorganism in the first two and bacteroides fragilis in the third patient. This is the first reported case resulting from this specific bacteria. None of our patients had any predisposing risk factor. CONCLUSIONS: A high index of suspicion is mandatory to enable early recognition of this rare clinical disease. CT scan is the standard diagnostic tool to confirm diagnosis. Prolonged drainage and appropriate antibiotics are essential for the successful treatment of primary psoas abscesses. ( info) |
40/180. psoas abscess as a complication of pyogenic sacroiliitis: report of a case. A psoas abscess is, either primary or secondary, a rare entity for a general surgeon. Images by ultrasonography and computed tomography (CT) can help a general surgeon to make an accurate diagnosis when encountering the patient complaining of unilateral lower abdominal deep pain with fever. A case of pyogenic abscess of the psoas muscle as a result of sacroiliitis in a 22-year-old man is reported herein. The abdominal CT and magnetic resonance imaging scans demonstrated a large multilocular abscess extending along the iliopsoas muscle, and erosion and a widening of the left sacroiliac joint. The abscess was drained with an open surgical approach and the patient responded well to antibiotic therapy. Aggressive surgical and medical treatment is necessary in patients with psoas abscess to prevent complications. ( info) |