1/8. Primary salmonella iliopsoas abscess: a case report.Primary iliopsoas abscesses are usually hematogenous or seeded via the lymphatic system from an occult focus. staphylococcus aureus has been reported to be the predominant pathogen, whereas salmonella sp has rarely been reported to be a major pathogen. We report the case of a 63-year-old woman who presented with a prolonged fever of two weeks' duration. On admission, physical examination revealed tenderness over the left lower abdomen and hip joint, with her thigh in constant flexion. Computerized tomography of the abdomen revealed an iliac fossa abscess. The drained pus culture yielded salmonella group B. Percutaneous catheter drainage and appropriate antimicrobial therapy with ciprofloxacin eventually yielded good results. There was no evidence of other underlying diseases predisposing the patient to the formation of iliopsoas abscess. salmonella infection should be considered in the diagnostic protocols of iliopsoas abscess in taiwan, where salmonellosis is prevalent.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/8. 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 = 1keywords = physical examination, physical (Clic here for more details about this article) |
3/8. Coil compaction after embolization of the superior mesenteric artery pseudoaneurysm.A 58-year-old man with an abscess of the psoas muscle was returned to our hospital with hematemesis. Two years earlier, he had undergone coil embolization for a superior mesenteric artery (SMA) pseudoaneurysm secondary to pancreatitis. Based on the physical examination, serum amylase level, and abdominal radiographs, a diagnosis of acute exacerbation of pancreatitis and coil compaction of the SMA pseudoaneurysm was made. The patient underwent re-embolization for the coil compaction using interlocking detachable coils. His condition improved gradually, and he was discharged 3 weeks later. To our knowledge, this is the first report of coil compaction of SMA pseudoaneurysm.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
4/8. Primary psoas abscess: report of one case.A 6-year-old girl was admitted to our hospital with the problems of persistent fever, limping gait, and right hip pain. On physical examination, flexion of the right hip with limitation of the range of motion was noted. Tenderness over the right inguinal area was also elicited. Pyogenic arthritis of the right hip was suspected. Aspiration of the right hip joint was negative. Two days later, a careful examination revealed that the Patrick's test was negative and a local tenderness on the right lower abdomen was found. laparotomy was performed under the impression of retroperitoneal abscess. The postoperative diagnosis was psoas abscess. After surgical drainage and antibiotics therapy, she was discharged 2 weeks later with good condition.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
5/8. Diagnosis and treatment of iliopsoas abscess in spinal cord injury patients.Six patients with spinal cord injury and iliopsoas abscess and other complicating conditions were evaluated with computed tomography (CT), conventional radiography, magnetic resonance imaging (MRI), and radionuclide scans. CT identified the presence of psoas abscess and revealed the depth, extent, and relationship of deep pressure ulcers to deep structures. CT-guided aspiration of the abscess cavities was performed in three patients, with placement of drainage catheters. Concurrent treatment with appropriate antibiotics, followed by staged myocutaneous flap coverage resulted successful outcomes in all patients. A high index of suspicion aids in the early diagnosis of psoas abscess in the SCI patient, as interpretations of physical examination are obscured by the lack of localizing findings. We believe that CT is the diagnostic and therapeutic modality of choice in the management of these complex conditions in the SCI patient, because of its superior ability to detect pathologic changes in the pelvic region and for decreasing the morbidity of the treatment by avoiding open surgery in these often suboptimal surgical candidates.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
6/8. Spinal infections in the immunocompromised host.There is an increasing population of immunocompromised patients with hiv, IV drug abuse, organ transplantation, and long-term steroid treatment developing spinal infections. delayed diagnosis because of blunted host immune response and lack of outward signs and symptoms places the treating physician at a disadvantage in the treatment of this type of disease, which presents at a later stage of development. Immunocompromised patients are infected by a different group of pathogens than their healthier cohorts (e.g., pseudomonas, gram-negative bacteria and fungal infections) because their host defenses are diminished. osteomyelitis with or with out pyomyositis and epidural abscess may occur. The overriding symptom is back pain. radiculopathy, myelopathy, and sensory loss may accompany local pain and tenderness. Plain film radiography, CT scan, MR image, and bone scan is invaluable in the diagnosis of these infections. The cornerstone of treatment is identification of the responsible pathogen, appropriate medical therapy, immobilization of the affected segment of the spine, and physical therapy to combat physical deconditioning. Psoas abscesses may require surgical debridement if they cannot be adequately drained by CT-guided percutaneous catheterization. Epidural abscesses with neurologic compromise require surgical drainage. Impingement of the spinal cord or cauda equina by collapsed osteomyelitic vertebral bodies requires surgical debridement by anterior vertebrectomy, with an autologous tricortical iliac crest strut and immobilization of the spine using external bracing or posterior instrumentation as dictated by the disease.- - - - - - - - - - ranking = 0.095836700163235keywords = physical (Clic here for more details about this article) |
7/8. Fulminating gas-forming psoas muscle abscess due to klebsiella pneumoniae following a deep neck infection.Psoas muscle abscess due to klebsiella pneumoniae infection is rare. We report a 55-year-old diabetic man who presented with progressive back pain of 1 month's duration. The patient had undergone surgical drainage for a deep neck infection with K. pneumoniae 43 days previously. On the present admission, physical examination revealed tenderness over the anterior upper aspect of both thighs, and computed tomography showed pneumoretroperitoneum dissecting the bilateral iliopsoas muscles. Parenteral administration of antibiotics was started immediately. Due to the patient's poor health status, we opted for repeated computed tomographic and sonographic-guided percutaneous drainage rather than surgical drainage. Blood and pus cultures revealed only K. pneumoniae. The patient recovered without significant sequelae. This report stresses the risk of metastatic infections caused by K. pneumoniae, especially in diabetic patients. Our experience suggests that repeated percutaneous drainage is feasible in cases of severe iliopsoas abscess, especially when risks associated with surgery are high.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
8/8. Primary iliopsoas abscess successfully treated by ultrasonographically guided percutaneous drainage.We report a case of primary iliopsoas abscess successfully treated by ultrasonographically guided percutaneous drainage. A 56-year-old man presented at our hospital with lumbago, right-sided back pain, fever (temperature 38.5 degrees C) and chills. On physical examination, we found dark red skin, swelling, and tenderness localized at the right side at the back of his waist. Laboratory examination showed leukocytosis (white blood cell count 9700/mm3) with a leftward shift and elevated c-reactive protein (5.2 mg/dl). ultrasonography (US), computed tomography (CT), and magnetic resonance imaging revealed a hypodense lesion in the right iliopsoas muscle extending to the subcutaneous tissue. About 50 ml of thick yellow pus was obtained by ultrasonographically guided aspiration drainage. A drain catheter was inserted in the abscess cavity. Laboratory findings improved and clinical symptoms abated rapidly after drainage. On the twenty-first day after drainage, US and CT showed that the abscess was no longer present. The patient was discharged after 32 days of hospitalization. As possible primary diseases causing iliopsoas abscess, such as digestive tract disease, tuberculosis, and osteomyelitis, were not found, we diagnosed the disease as primary iliopsoas abscess. Although surgical drainage has been performed in most reported cases of iliopsoas abscess, this case report shows that ultrasonographically guided percutaneous drainage is also effective for treating primary iliopsoas abscess if it is diagnosed early enough.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |