Tuberculous Psoas Abscess Research Articles

A Case of Pott’s Disease Complicated by Tuberculous Meningitis and Psoas Abscess Diagnosed by Computed Tomography-Guided Percutaneous Drainage

A Case of Pott’s Disease Complicated by Tuberculous Meningitis and Psoas Abscess Diagnosed by Computed Tomography-Guided Percutaneous Drainage

Perinephric and psoas abscesses leading to empyema: An unusual tuberculosis presentation

Tuberculous psoas abscess usually results from tuberculous spondylitis but may also develop from direct spread or via hematogenous route [1]. Our case involves direct spread from an adjacent perinephric abscess with associated thoracic extension from suspected direct erosion or a diaphragmatic defect. We present a case of pleural empyema arising from abdominal tuberculous abscesses. This is an 11-year-old male who initially presented with a three-week history of cough, intermittent fever, and dyspnea. Congenital diaphragmatic hernia was first suspected at the emergency department when an opacified left hemithorax with cystic lucencies was noted. Further imaging of the chest and upper abdomen was done in our institution revealing large left perinephric and psoas abscesses with intra-thoracic extension resulting in empyema thoracis and necessitans. Culture of the abscess fluid yielded no growth but GenExpert tested positive for M. tuberculosis. Tuberculosis remains a major illness in developing countries and has a multitude of infection sites and clinical presentation. Our case presented as an ascending thoracic extension of a perinephric and psoas abscess, likely from a diaphragmatic defect. The absence of spinal involvement proves its renal origin. The importance of CT scan is highlighted in medically-confounding cases such as this one.

Abses Psoas Tuberkulosis

<p><em>Psoas abscess is a rarely found abscess located in the iliopsoas compartment. It characterized by fever, back pain, and limitation of hip movements. Psoas abscess is hard to diagnose due to only 30% of classic symptoms and signs are found. In this study we discussed tuberculous psoas abscess in patient 26 years old male. Anamnesis, physical examination, and supporting medical tests were done to diagnose tuberculous psoas abscess. Therefore we performed abscess incision and drainage, followed by continuous tuberculous therapy.</em></p><p><strong>Keywords: tuberculous psoas abscess</strong></p><p> </p>

Diagnosis and treatment of Tuberculous primary psoas abscess

Objective: To retrospective analysis the clinical characteristics of diagnosis and treatment the disease of tuberculous psoas abscess (TPA). Method: The medical records of 13 consecutive patients presenting to our hospital with TPA were reviewed from November 2002 to December 2015.Demographic data, presenting features, predisposing factors and the investigations performed were recorded and the outcomes were analysed. Results: The thirteen patients were included, 11 cases all had lower backache, 6 cases had Lower abdomen or groin area pain, 2 cases had fever, eleven cases were treated with Open drainage, one with Ultrasound guided drainage, and the last case used antibiotics alone, median hospital stay of 35 days, follow-up showed no recurrence or death in patients. Conclusion: The incidence of TPA is probably underreported.The vague presentation leads to delays in diagnosis and increases morbidity and a high index of suspicion is the key to early diagnosis.Open drainage has Lower recurrence and death rates, and used widely, is the most reliable method for the treatment of primary tuberculous psoas abscess.

Large Primary Tuberculous Psoas Abscess in an HIV Patient – A Case Report

Tuberculosis (TB) remains as one of the leading opportunistic infection in patients with Human immunodefficiency virus (HIV) infection in developing countries. Here we report a case of huge primary psoas abscess of tubercular origin in an HIV patient who presented with hip pain and limping. Psoas sign was evident on examination and CT scan of abdomen revealed a large iliopsoas abscess extending from abdomen to upper part of thigh. Patient underwent percutaneous drainage of abscess and improved with anti-tuberculous drugs while continuing anti-retroviral therapy.DOI: http://dx.doi.org/10.3126/saarctb.v11i2.12437SAARC J TUBER LUNG DIS HIV/AIDS, 2014;XI(2), Page: 34-36

A case of skeletal tuberculosis and psoas abscess: disease activity evaluated using 18 F-fluorodeoxyglucose positron emission tomography-computed tomography

BackgroundPsoas abscess complicating tuberculous spondylitis is a rare morbidity in extrapulmonary tuberculosis. There are no established guidelines for evaluating the clinical response of psoas abscess. Although several studies have shown that positron emission tomography-computed tomography with 18 F-fluorodeoxyglucose can play a potential role in diagnosing multifocal tuberculosis and monitoring the clinical response of pulmonary tuberculosis, to our knowledge, this is the first report demonstrating that positron emission tomography-computed tomography is useful for evaluating local inflammation and disease activity of a tuberculous psoas abscess.Case presentationWe report a case of multifocal bone and lymph node tuberculosis with concomitant lumbar psoas abscess in a 77-year-old man, along with a literature review. An initial positron emission tomography-computed tomography scan showed intense 18 F-fluorodeoxyglucose accumulation in the sternum, ribs, vertebrae, and lymph nodes. The patient was successfully treated with antitubercular agents and computed tomography-guided drainage therapy. A follow-up positron emission tomography-computed tomography after abscess drainage and 9 months of antitubercular drug treatment revealed that the majority of lesions improved; however, protracted inflammation surrounding the psoas abscess was still observed. These results indicate that disease activity of psoas abscess can remain, even after successful drainage and antitubercular medication regime of appropriate duration.ConclusionWe have successfully followed up the extent of skeletal tuberculosis complicated with psoas abscess by positron emission tomography-computed tomography. In this patient, positron emission tomography-computed tomography is useful for evaluating the disease activity of tuberculous psoas abscess and for assessing the appropriate duration of antitubercular drug therapy in psoas abscess.

Molecular diagnosis of psoas abscess secondary to Pott's spine

Introduction Tuberculosis (TB) is the world’s leading infectious cause of mortality after acquired immunodeficiency syndrome (1). The incidence of extrapulmonary and atypical manifestations of TB is increasing. In 10 to 25% of cases, TB presents as an extrapulmonary infection. The skeletal form of the disease is responsible for 3% of the total number of cases, with 50% of these being spinal TB, often called Pott’s disease (2). One of the complications of spinal TB is an abscess of the psoas muscle; however, reports of tuberculous psoas abscess (PA) remain rare. The exact incidence of PA is unknown, but it probably has increased in the last few years because of the availability of improved diagnostic tests.

A CASE OF TUBERCULOUS PSOAS ABSCESS SUCCESSFULLY TREATED WITH SURGERY DURING ANTITUBERCULOSIS THERAPY FOR MILIARY TUBERCULOSIS

A case of tuberculous psoas abscess complicated during antituberculosis therapy for miliary tuberculosis and successfully treated with surgery was reported. A 20-year-old man visited our hospital because of fever lasting for 3 months. Chest radiography showed miliary nodules in both lungs and transbronchial lung biopsy revealed granuloma. Magnetic resonance imaging of the head showed small lesions in the brain. Computed tomography of the abdomen showed an enlarged paraaortic lymph node and a nodule in the spleen. Needle biopsy of the lymph node revealed necrotic tissue. Mycobacterium tuberculosis was not isolated; however, miliary tuberculosis was highly suspected based on clinical and radiographic findings. Once antituberculosis therapy was initiated with isoniazid, rifampicin, streptomycin, and pyrazinamide, the fever subsided. In spite of improvement of general radiographic findings, a new abscess was found in the right psoas major muscle after 8 months of therapy by computed tomography. A sample of the abscess showed a positive smear, negative culture, and positive PCR test for M. tuberculosis. Although antituberculosis therapy continued for another 6 months, the abscess enlarged to 7 cm and new retroperitoneal lymph nodes also appeared. Surgical drainage and curettage of the abscess was performed. Intra- and post-operative specimens were negative for bacteria, fungi, and M. tuberculosis. The patient was treated with isoniazid, rifampicin, and ethambutol for one year postoperatively. The disease disappeared without any evidence of relapse for 2.5 years after surgery.

Tuberculous Abscess of the Psoas Muscle in a Patient with Acute Lumbar Burst Fracture: A Missed Diagnosis.

The authors present a rare case of tuberculous spondylitis and a large abscess in the left psoas muscle that occurred after spinal surgery for an acute traumatic burst fracture of the L2 vertebral body. We retrospectively reviewed the patient's first magnetic resonance imaging (MRI) we found that some unusual findings, indicative of psoas abscess had been overlooked. As a result, diagnosis and treatment of tuberculous psoas abscess and spondylitis were considerably delayed. Despite the critical condition of patients in a similar emergency, surgeons should always pay close attention to the radiological findings and clinical symptoms of the patient before considering a surgical intervention or biopsy.

Tuberculous psoas abscess mimicking soft tissue tumour

A 62-year-old Caucasian school dinner lady presented to her family doctor with a 2-year history of recurrent urinary tract infections. She was otherwise well, with no significant past medical history. Full blood count, urea and electrolytes, and bone biochemistry were normal. Urine culture was sterile. An abdominal ultrasound scan detected a left-sided mass in the iliolumbar region and scarring of the left kidney. The patient was referred to the authors' sarcoma unit with a suspected retroperitoneal soft tissue tumour causing obstructive renal damage.

Dual time point imaging of FDG PET/CT in a tuberculous spondylodiscitis

Dual Time Point Imaging (DTPI) technique is a specialised protocol adopted in 18F-Fluorodeoxyglucose (FDG) Positron Emission Tomography (PET) imaging. This technique is claimed to be useful in differentiating malignant and infective lesions. The authors adopted this technique in a patient diagnosed with tuberculous spondylodiscitis and psoas abscess which demonstrated higher Maximum Standardized Uptake Value (SUVmax) during initial scans as compared with those obtained on delayed scans. The SUVmax changes between the two time points are believed to be a valuable finding for chronic granulomatous infective lesions such as tuberculosis.

A rare cause of lower abdominal and pelvic mass, primary tuberculous psoas abscess: a case report.

IntroductionTuberculous psoas abscess was usually associated to complicate Pott's disease, but it can also be secondary to direct extension from other adjacent structures or haematogenous spread from an occult source. However, the occurrence of this entity as the presenting manifestation of tuberculosis, without evidence of active infection elsewhere, has been seldom reported.Case PresentationWe report a clinical case of a 64-year-old immunocompetent female that presented with left lower abdominal pain and a soft tissue mass over the left iliac fossa and inguinal regions due to a primary tuberculous psoas abscess. Early diagnosis and prompt treatment with percutaneous drainage guided by ultrasound along with antituberculous drugs, lead to a satisfactory outcome.ConclusionThe purpose of this case report is to point out attention to the diagnostic challenge of tuberculous psoas abscess in the absence of tuberculosis in other organs or a predisposing condition. A brief review of the literature about its epidemiology, etiology, clinical features and management is discussed over the text.

La gestione percutanea delle complicanze della spondilodiscite tubercolare: risultati nel breve-medio periodo

Psoas abscesses are the most frequent complication of tuberculosis with skeletal involvement. The aim of this paper is to report our experience with the systematic application of percutaneous drainage to tuberculous psoas abscesses. Between January 1997 and December 2005, 23 patients (14 men and nine women; age range 21-48 years), after a previous study with computed tomography (CT) and/or magnetic resonance (MR) imaging, underwent percutaneous drainage of a tuberculous fluid collection in the psoas muscles. Follow-up consisted of monthly clinical and laboratory assessment, and plain chest radiography and spinal CT every 6-12 months. Spondylodiscitis involved the thoracolumbar spine. Fluid collections were bilateral in 14 cases and communicating in ten of these. Maximum transverse diameter was 7 cm, whereas longitudinal diameter was 14 cm. Placement of the drainage catheter was successful in all cases, and the catheter was left in place for 5-36 (mean 18.4) days. Symptom regression occurred immediately after drainage of the fluid collection. The drainage procedure was curative in 100% of cases. Dislodgement of the drainage catheter occurred in two cases as a result of excessive traction during dressing removal. A serious complication of bone tuberculosis, psoas abscesses, can be effectively treated by percutaneous drainage, leading to immediate pain resolution. The drainage catheter requires daily monitoring to identify when it can be safely removed without risk of recurrence.

A Case of Tuberculous Psoas Abscess Caused by Tuberculous Lymphadenopathy

A tuberculous psoas abscess is a frequently described complication of tuberculous spondylitis. Although rare, a tuberculous psoas abscess can develop without any demonstrable spinal involvement. In patients with no evidence of sponylitis, the abscess may result from direct spread from the involved lymph node or via a hematogeous route. The treatment of a psoas abscess is either drug therapy or surgical intervention in conjunction with drug therapy. Image-guided percutaneous drainage in conjunction with drug therapy is also a safe and effective treatment for a tuberculous psoas abscess. We report an unusual case of bilateral tuberculous psoas abscesses without any concomitant spinal involvement. The tuberculous psoas abscess may have formed by fistulization between the necrotic lymph node and psoas sheath. The diagnosis was confirmed by computed tomography and a histology examination of the biopsy sample. The patient improved after administering anti-tuberculous agents for 2 years along with surgical and percutaneous drainage of the abscess. (Tuberc Respir Dis 2008;65:517-521)

Laparoscopic Drainage of Bilateral Tuberculous Psoas Abscesses

Psoas abscess secondary to Mycobacterium tuberculosis infection is rare in industrialized countries. Standard treatment options for psoas abscess of any etiology include percutaneous drainage under radiographic guidance and surgery, which is reserved for failure of conservative therapy. A case of bilateral tuberculous psoas abscesses is reported and a surgical method of drainage utilizing a totally extraperitoneal laparoscopic approach is described.

Bilateral psoas abscesses in an HIV-positive patient

Patients with HIV can often present a diagnostic challenge and may have atypical presentations of more common diseases. This case demonstrates such a scenario; we describe a 35-year-old man with a recent diagnosis of HIV infection complaining of backache, anorexia and weight loss. On investigation he was found to have bilateral tuberculous psoas abscesses. A review of the literature shows that this is a rare presentation of an already unusual problem, with subtle signs requiring a high index of clinical suspicion. However, with HIV-positive patients more likely to present with extrapulmonary tuberculosis, there is need for increased awareness of this diagnosis.

Abcès tuberculeux du psoas sans atteinte rachidienne associée. À propos d’un cas

Introduction. – Tuberculous psoas abscess outside of locoregional causes is uncommon and can cause a problem of differential diagnosis. Exegesis. – We report a case of unilateral tuberculous abscess of the psoas which first clinical and radiological features presented like a retroperitoneal tumor. Exploration laparotomy discovered a bulky abscess of the left psoas muscle. Bacteriologic and histologic evaluation confirmed the tuberculous origin. Radiological study of the spine did not show any signs of spondylodiscitis. Under antituberculosis treatment a crural collection occurred and a surgical drainage was performed. Five years later, there was a recurrence of a crural collection which responded well to antituberculosis treatment. Conclusion. – Tuberculous psoas abscess is usually secondary to spinal involvement, more uncommonly to digestive, urologic or genital tuberculosis. Primary abscess was rarely described and the pathogenesis remains unclear. Psoas contamination is supposed to be hematogenous or lymphatic in origin. Ultrasonography and computed tomography (CT) transformed the diagnosis and the therapeutic approach by percutaneous puncture and drainage.

Ilio-psoas abscesses: Percutaneous drainage under image guidance

Over a 5-year period, 56 psoas abscesses occurring in 51 patients were managed by image-guided percutaneous drainage, either by needle aspiration (n = 10) or by catheter drainage (n = 46) in conjunction with medical therapy. Twenty-seven patients had tuberculous abscesses (bilateral in five) while 24 patients had pyogenic abscesses. Percutaneous treatment was successful in 16 of the 24 patients (66.7%) with pyogenic abscesses. The reasons for failure were co-existent bowel lesions, phlegmonous involvement of muscle without liquefaction, multiloculated abscess cavity and thick tenacious pus not amenable to percutaneous drainage. Surgery was required in seven patients, either for failed percutaneous drainage or for the management of co-existent disease. Percutaneous drainage was initially successful in all 27 patients of tuberculous psoas abscesses. However, eight patients presented with recurrence requiring repeat intervention. The average duration of catheter drainage was longer in patients with tuberculous abscess (11 days) than in patients with pyogenic abscess (6 days). Percutaneous drainage under image guidance provides an effective and safe alternative to more invasive surgical drainage in most patients with psoas abscesses.

Percutaneous catheter drainage of tuberculous and nontuberculous psoas abscesses

Objective: To assess the utility of percutaneous catheter drainage in the management of tuberculous and nontuberculous psoas abscesses associated without any bony involvement or with minimal bony lesions that could not cause vertebral instability. Materials and method: Eleven patients with psoas, iliopsoas and pelvic abscesses were drained under computed tomography and ultrasono-graphy guidance. Results: There were 15 (10 tuberculous, 5 pyogenic) abscesses in 11 patients. Six of the tuberculous abscesses and one of the pyogenic abscess were associated with vertebral involvement. Vertebral lesions were located in one or two vertebrae without causing any serious disturbance in the vertebral stabilization. In one case, the abscess was bilateral. Nine cases were drained under computed tomography guidance, while two cases were drained under both computed tomography and ultrasonography guidance. One session drainage was sufficient for abscess resolution in uniloculated cases. In the two of four multiloculated cases, catheter drainage was performed twice. Relapse of the abscess was found in only one patient. The mean abscess volume was 520 ml and mean drainage duration was 12 days. None of the cases required surgery. Conclusion: Percutaneous drainage, chemotherapy and additional external brace application with the cases associated with bony lesion may be used for treatment of tuberculous and nontuberculous unilocule and multiloculated abscesses.

A SUCCESSFULLY OPERATED CASE OF TUBERCULOUS ABDOMINAL ANEURYSM WITH TUBERCULOUS SPONDYLITIS AND TUBERCULOUS PSOAS ABSCESS

Tuberculous aortic aneurysm is a rare entity. We experienced a rapidly growing abdominal aortic aneurysm with tuberculous spondylitis and tuberculous psoas abscess. A 67-year-old man was admitted to the hospital because of an abdominal aneurysm. Tuberculous psoas abscess had been pointed out at a laparotomy for a gastric cancer 6 months before and lumbago and low grade fever lasted for 3 months. There was a previous history of suffering from tuberculous pleuritis and tuberculosis of left shoulder joint. Abdominal CT showed an abdominal anuerysm and in course of time it progressively increased in size. After antituberculous chemotherapy, the abdominal aneurysm, tuberculous spondylitis and tuberculous psoas abscess were resected and the aorta was grafted with a Gore Tex prosthesis. Her has been well for the past 2 years after the surgery. We consider that the in-situ operation using an artificial graft is possible with complete resection of tuberculous combined lesions and effective chemotherapy.