Unusual cases of tuberculous psoas abcesses

Abstract

The authors report three cases of tuberculous psoas abscesses in which either the diagnosis was problematic, and the treatment difficult, or the location and extension of the abscess was unusual. In the first case the long duration of the abscess led to condensation of its purulent content and it developed an extremely callous and sclerotic abscess wall which prevented the collapse of the abscess cavity and made it incurable. In the second case little brain tuberculomas were misdiagnosed as multiple metastases. The patient's increasing low back pains drew attention to the lumbar spine and further examination revealed destruction of two vertebral bodies accompanied by a right psoas abscess. CT guided percutaneous drainage emptied the abscess. Antituberculous drug therapy led not only to the healing of the vertebral process but to the disappearance of the brain tuberculomas. In the third cases giant bilateral psoas abscesses were caused by a relatively minor tuberculous destruction of the lumbar spine. The abscess on the left side sank to the trochanteric region and in between the adductor muscles. Exploration of both psoas and thigh abscesses in one session led to the quick recovery of the patient. The diagnosis of all three cases was proved by bacteriolgy and in the first and third cases by histology as well.