Ilio-psoas abscesses: Percutaneous drainage under image guidance

Gupta, Shailesh Kumar; Suri, Sudha; Gulati, Malvika; Singh, Paramjeet

doi:10.1016/s0009-9260(97)80036-0

Cited by 67 publications

(46 citation statements)

References 16 publications

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“…The first IPA radiologic (US, CT) guided percutaneous drainage occurred in 1984 9 , and since then, the best therapeutic option has been on debate. So far, the treatment choice is the guided percutaneous drainage, as it is the least invasive and associated with lower morbidity and mortality 10 ; however, many local and systemic factors of each patient may influence the therapeutic choice 11 .…”

Section: Bilateral Paracoccidioidomycotic Iliopsoas Abscess Associatementioning

confidence: 99%

Bilateral paracoccidioidomycotic iliopsoas abscess associated with ileo-colonic lesion

Duani

Nunes

Assumpção

et al. 2012

Rev. Soc. Bras. Med. Trop.

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FIGURE 1 -Colonoscopy revealing the cecum and the ileocecal valve, a large ulcer, and an ulcer with fibrin (arrows). Revista da Sociedade Brasileira de Medicina Tropical 45(5):649-651, Sep-Oct, 2012Case Report ABSTRACT This case report shows the clinical development of a patient with systemic paracoccidioidomycosis presenting with lymphatic-intestinal manifestation. The patient initially had a substantial clinical improvement but had a recrudescence after six months of sulfamethoxazoletrimethoprim oral treatment, with the emergence of feverish syndrome, lumbar pain, and intermittent claudication, characterizing a bilateral iliopsoas muscle abscess, necessitating clinicosurgical therapeutics.Keywords: Paracoccidioidomycosis. Psoas abscess. Paracoccidioides brasiliensis.fungal smear; normal renal and hepatic function panels; and negative microbiological stool tests. An abdominal and pelvic computed tomography (CT) demonstrated mesenteric lymphadenomegaly, with a hypodense center. Colonoscopy evidenced multiple deep ulcers with changeable sizes and forms along the whole colon, intercalated by normal mucosa, and a deformed ileocecal valve, which favored the diagnosis of infectious ulcerative pancolitis (Figure 1). Anatomopathological examination of the colonic mucosa revealed some areas of erosion covered in fibrino-leukocytic exudate, inflammatory infiltrate in corion, with some multinucleated giant cells, and lots of round shaped yeast, in various sizes, compatible with ileum-colonic PCM (Figure 2). A biopsy of a cervical lymph node also was performed, and in the anatomopathological examination, we found the Paracoccidioides brasiliensis, with non-caseating granulomas containing multinucleated giant cells and epithelioid histiocytes, presenting a steering wheel shape, compatible with PCM granulomatous lymphadenitis. During hospitalization, the patient was treated with venous sulfamethoxazole-trimethoprim (SMX-TMP) and amphotericin B (amphoB) deoxycholate, receiving a cumulative dose of 1,900mg after www.scielo.br/rsbmt 650 Duani H et al -Bilateral paracoccidioidomycotic iliopsoas abscess DISCUSSION 38 days. A complete regression of lymphadenopathy occurred, the patient gained weight, and the diarrhea ceased. After 40 days from admission, he was discharged, with a prescription of a daily use of SMX-TMP 800 + 160mg.The patient returned 40 days later, presenting recrudescence of the initial symptoms, including pain in the left hip, limited extension of the homolateral hip, limping, and fever. Furthermore, cultures were obtained, and an anatomopathological examination of an inguinal lymph node biopsied revealed Paracoccidioides brasiliensis. He was rehospitalized and treated with amphoB plus oral itraconazole and sulphadiazine.Abdominal and pelvic CT showed mesenteric lymphadenomegaly, enlargement of the left iliac and psoas muscles, with inner voluminous liquefaction, which extended from the level of the third lumbar vertebra (L3) to the pelvis. Moreover, a smaller collection was observed in the right psoas muscle at...

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Section: Bilateral Paracoccidioidomycotic Iliopsoas Abscess Associatementioning

confidence: 99%

Bilateral paracoccidioidomycotic iliopsoas abscess associated with ileo-colonic lesion

Duani

Nunes

Assumpção

et al. 2012

Rev. Soc. Bras. Med. Trop.

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“…Psoas abscesses are usually treated with ultrasound guided percutaneous drainage (PCD) and appropriate antitubercular therapy (ATT) [11]; however, some patients may require surgery. Our patient responded well to open drainage followed by ATT (on Rifampicin, Isoniazid, Ethambutol and Pyrazinamide for six months) correlating with the fact that primary psoas abscess has better prognosis than that of secondary to other causes.…”

Section: Discussionmentioning

confidence: 99%

Primary tubercular psoas abscess: a rare presentation

Chawla

D’Souza

Bhat

et al. 2011

J Infect Dev Ctries

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Primary tubercular psoas abscess is a rare clinical entity and has seldom been reported in an otherwise healthy person. Here we report an interesting case of primary tubercular psoas abscess in an immunocompetent male with no other traceable source. Case reportA 35-year-old male ayurvedic doctor was admitted to a tertiary care hospital with complaints of pain associated with movements in the left hip joint, low-grade persisting fever, progressive loss of appetite, and loss of weight for the last six months. Chest examination was within normal limits and there was no lymphadenopathy. The patient had a history of cholecystectomy two years earlier. There was no past or family history of tuberculosis, hypertension, or diabetes mellitus. He was earlier treated for enteric fever due to significant Widal titre levels and the fever subsided. Meanwhile the patient travelled to Kuwait for a month, where he again had fever and was treated with paracetamol for fever and diclofenac ointment for hip pain. As he returned to India, Brucella agglutination test revealed a significant titre of 1:320. The patient was treated with doxycycline and rifampicin for 10 days by a local physician. The Brucella agglutination test was repeated after treatment and the titre was found to be 1:160, whereas erythrocyte sedimentation rate was 120 mm at the end of the first hour. Peripheral blood smear revealed hypochromic microcytic anaemia with neutrophilia and thrombocytosis. The patient was further continued with intravenous paracetamol and doxycycline. However, fever was still persistent despite treatment and the patient stopped working. As there was no improvement, he was admitted to our tertiary care hospital. On examination, blood tests showed HBsAg positive for hepatitis B and raised Creactive protein (88.1mg/L). Titres for the Brucella agglutination test and widal test were negative. Blood and urine cultures were sterile. Other serological tests for HIV, antinuclear antibody, rheumatoid factor and HBcAg were negative. Ultrasonography of the abdomen indicated mild splenomegaly. Echocardiogram was normal. A bone marrow trephine biopsy was performed and sent for histopathology; however, it was not possible to form a conclusion because of the inadequate sample size. Bone marrow culture yielded a growth of Pseudomonas spp., which was probably an environmental contaminant. Technetium-99 m bone scan did not show any hot spots in the spine ( Figure 1). Magnetic resonance imaging of the hip joint (done outside) indicated inflammatory changes in the ala of the sacrum on left with a large collection in the left iliopsoas muscle and pre sacral space communicating with the gluteal region through the sciatic notch suggestive of abscess (Figures 2A and 2B). Repeated ultrasonography indicated loculated fluid (approximately 540 ml) collection with internal septations involving the left iliacus and psoas muscle measuring 25 x 6.7 x 6 cm and extending up to the insertion of the iliopsoas muscle.The left iliopsoas abscess was drained by open later...

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“…CT can also identify a retroperitoneal or intra-abdominal disease process as the cause for the abscess. It also allows the simultaneous drainage of the abscess by percutaneous needle aspiration [11,25,26].…”

Section: Discussionmentioning

confidence: 99%

“…The treatment is based on drainage of the abscess and antibiotics [26]. Secondary abscesses may also require management of the infected focus.…”

Section: Discussionmentioning

confidence: 99%

Psoas Abscess after Radical Abdominal Hysterectomy: A Case Report and Review of the Literature

Spiliopoulos¹

2010

TOCCJ

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Abstract:We report a case of a 38-year-old woman who presented with right lower quadrant abdominal pain and occasional fevers, five weeks after radical abdominal hysterectomy and pelvic node dissection for cervical carcinoma. After initial empirical antibiotic treatment failure, a decision was made to proceed with percutaneous drainage of a right psoas abscess. The antibiotic regimen was adjusted according to the culture results from the abscess. The patient's condition improved in the next 36 hours. The patient was discharged six days later on oral antibiotic treatment for four weeks.Psoas abscess is a rare condition in general obstetrics and gynecology and its incidence in gynecological oncology is very low. This is a potentially fatal condition with difficult diagnosis and treatment. Appropriate management of these cases should include suspicion and confirmation of the diagnosis and aggressive medical and surgical treatment.

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Ilio-psoas abscesses: Percutaneous drainage under image guidance

Cited by 67 publications

References 16 publications

Bilateral paracoccidioidomycotic iliopsoas abscess associated with ileo-colonic lesion

Bilateral paracoccidioidomycotic iliopsoas abscess associated with ileo-colonic lesion

Primary tubercular psoas abscess: a rare presentation

Psoas Abscess after Radical Abdominal Hysterectomy: A Case Report and Review of the Literature

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