Primary psoas abscess extending to thigh adductors: case report.

Zhongjie Zhou,Yueming Song,Jiancheng Zeng,Qianyun Cai

doi:10.1186/1471-2474-11-176

Abstract

BackgroundPsoas abscess is a rare condition consisting of pyomyositis of the psoas. The worldwide incidence was 12 cases per 100,000 per year in 1992, but the current incidence is unknown. Psoas abscess can descend along the psoas sheath and reach the inner upper third of the thigh, but only infrequently does it penetrate the sheath and involve the thigh adductors. Because of insidious clinical presentation, the diagnosis of psoas abscess is a challenge. Delayed diagnosis can result in poor prognosis.Case presentationA 45-year-old male with no significant past medical history presented with pain in the left thigh, and limitation of movement at the left hip and knee joint for one month. Ultrasound, CT, and MRI revealed a liquid mass in the left psoas. Percutaneous drainage of this mass yielded 300 ml pus from the psoas. After surgery, the patient reported relief of pain; however, ten days after removal of the drainage tube, the patient complained of persistent pain in his left thigh. CT revealed that the psoas abscess had extended inferiorly, and involved the entire set of adductors of the left thigh. Open surgical drainage was performed at the flank and at the thigh, yielding 350 ml of pus from the thigh. After open drainage and adequate antibiotic therapy, the patient made a good recovery. Follow-up CT confirmed complete resolution of the abscess.ConclusionsLarge psoas abscess can penetrate the psoas sheath, and descend to thigh adductors even after percutaneous drainage. Appropriate treatment includes open surgical drainage along with antibiotic therapy.

Highlights

Psoas abscess is a rare condition consisting of pyomyositis of the psoas
The diagnosis is aided by radiologic testing; CT is useful in making a definitive diagnosis, but ultrasound can be a good choice to detect a large psoas abscess
Treatment involves the use of appropriate antibiotics along with drainage of the abscess

Summary

Background

The psoas muscle is a retroperitoneal muscle that originates from the lateral borders of the 12th thoracic to fifth lumbar vertebrae, and ends as a tendon that inserts into the lesser trochanter [1]. Ten days prior to presentation, his symptoms had worsened, and he began to have flank pain. The pain exacerbated when he lifted his left thigh against the examiner’s hand He reported no tenderness to palpation or percussion of his lumbar vertebrae. Ultrasound guided percutaneous drainage yielded 300 ml of pus from the psoas muscle; culture of this material detected Staphylococcus aureus. A drain was left in situ after the percutaneous drainage, and was removed 5 days later when the catheter had had no output for 2 consecutive days. His temperature returned to normal; ten days later, the patient complained of persistent pain in his left thigh. Follow-up CT scan performed one month after surgery revealed complete resolution of the abscess

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Discussion

Conclusions