Characteristics and Outcomes of Psoas Abscess: Experience From a Tertiary Care Center in North India

Abstract

BackgroundPsoas abscess (PA) is an uncommon disease involving infection of the psoas muscle with abscess formation. The evidence concerning clinical and diagnostic characteristics of PA and its outcomes is limited. The literature is heterogenous, with varying presentations and outcomes in different regions worldwide. We present a retrospective analysis of the clinical, radiological, and laboratory characteristics of PA, its management, and outcomes from a tertiary care center in North India. MethodologyWe reviewed the clinical records of confirmed cases of PA treated in our institute from January 2016 to December 2020 with a minimum follow-up of one year. Further, we performed a descriptive analysis of demographic characteristics, clinical features, laboratory parameters, radiological investigations, the basis of diagnosis confirmation, causative microorganisms, definitive management, treatment outcomes, and complications. ResultsWe reviewed 33 cases with a mean age of 29.9 ± 16.8 years. Overall, 48.4% of PAs were right-sided, and 24.2% were bilateral. Abdominal discomfort was the most common presenting symptom. Blood laboratory parameters were mostly within the near-normal range except for the elevated erythrocyte sedimentation rate, C-reactive protein, and neutrophil-to-lymphocyte ratio. Ultrasonography was the most commonly performed radiological investigation and was the basis of diagnosis confirmation. Mycobacterium tuberculosis was the most common causative microorganism. Most patients required percutaneous drainage, and around one-fourth required open drainage. All patients had symptomatic as well as radiological improvement and no major complications. ConclusionsTuberculosis is the most prevalent cause of PA in the North Indian population. Most patients respond well to the less invasive treatment with percutaneous therapeutic drainage and antitubercular drugs, with few patients requiring open drainage. However, tissue diagnosis may remain inconclusive in a few patients, and antitubercular treatment may need to be initiated based on the clinicoradiological evaluation. Nevertheless, the rate of complications is low, with nil mortality probably related to the mild-to-moderate disease course of tuberculosis.

Clinical Characteristics and In-Hospital Outcomes in Patients with Iliopsoas Abscess: A Multicenter Study

“…In recent years, because imaging modalities, e.g., gallium-67 inflammation scan, computed tomography, and magnetic resonance imaging, have undergone major advances in their speed, resolution, and multiplanar capacity, a growing body of literature reports cases of IPA [2,10,11]. Besides the improved diagnostic techniques, the aging population and the increase in immunocompromised hosts contribute to the rise of the incidence rate of IPA as well [2,12].…”

Psoas Abscess Precipitated by an Uncommon Pathogen: Pasteurella multocida

“…Risk factors for developing a psoas abscess include diabetes mellitus, alcoholism, acquired immunodeficiency syndrome, immunosuppression, injection drug use, Crohn's disease, and malnutrition [5]. Atypical pathogens such as Pasteurella multocida have been rarely reported in the literature as a cause of psoas abscesses [2,[5][6][7]. Pasteurella multocida is most commonly introduced into the body following a bite or a scratch from domestic pets such as dogs or cats and mainly causes cellulitis at the site of the injury.…”

“…The main function of this muscle is to flex and externally rotate the hip joint. A psoas abscess is most frequently seen in children and young adults; however, it is an unusual infection in adults with a reported incidence worldwide of 0.4 cases per 100,000 individuals [ 2 ]. These abscesses are believed to arise from either hematogenous spread from distant sites, trauma to the hip or lumbar areas, or contiguous spread from adjacent structures (sigmoid colon, appendix, ureters, abdominal aorta, kidneys, and pancreas) [ 3 ].…”

Inserção de cateter de Shilley para manejo de grande abscesso do músculo psoas em mulher jovem: relato de caso

“…Anatomicamente, o músculo psoas se localiza próximo de importantes estruturas abdominais, como órgãos do trato gastrintestinal, dos rins e vias urinárias, grandes vasos e cadeias linfáticas, por isso o acometimento infeccioso de quaisquer dessas muitas estruturas podem se espalhar com facilidade por contiguidade. Ademais, o plexo lombar transcorre a partir do MP, e por isso quando comprometido, muitas vezes pode levar a déficits sensoriais e fraqueza muscular [1,2].…”

“…A funcionalidade desse músculo, é basicamente promover a flexão da coxa sobre o quadril, sendo mínima a ação de rotação lateral e abdução da coxa. Vale ressaltar, a proximidade e envolvimento do músculo ilíaco, que forma o compartimento iliopsoas, no qual pode haver a formação do abscesso, porém o abscesso de músculo psoas pode ou não ter envolvimento do músculo ilíaco [1,2,4].…”