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Introduction

Introduction
• The psoas muscle is a retroperitoneal organ
that originates from the lateral borders of
the 12th thoracic to fifth lumbar vertebrae
and inserts on the lesser trochanter of the
femur.

Introduction
• The psoas muscle lies in close proximity to
many other organs, including the sigmoid
colon, jejunum, appendix, ureters, aorta,
renal pelvis, pancreas, iliac lymph nodes,
and spine.
• Infections in these organs can contiguously
spread to the psoas muscle.
• The psoas muscle has a rich vascular
supply that is believed to predispose it to
hematogenous spread from sites of occult
infection.

Pathophysiology

Pathophysiology
• Primary psoas abscess
– intravenous drug users,
– diabetes,
– Immunosupression
– renal failure.
– human immunodeficiency virus (HIV).

Pathophysiology
• Secondary psoas abscess
– Gastrointestinal
• Diverticulitis, appendicitis, Crohn's disease,
colorectal carcinoma, appendiceal tumor
– Genitourinary
• Urinary tract infection, extracorporeal shock wave
lithotripsy, cancer
– Musculoskeletal
• Vertebral osteomyelitis, lumbar spondylodiskitis,
infectious sacroiliitis, septic arthritis
–

Pathophysiology
• Secondary psoas abscess
– Other
• Endocarditis, femoral artery catheterization, infected
abdominal aortic aneurysm, hepatocellular
carcinoma, trauma, intrauterine contraceptive
device, acupuncture, spinal surgery sepsis,
suppurative adenitis, long-term hemodialysis or
peritoneal dialysis

Bacteriology

Bacteriology
• Primary psoas abscess
– Staphylococcus aureus
– Serratia marcescens,
– Pseudomonas aeruginosa,
– Haemophilus aphrophilus
– Proteus mirabilis.

Bacteriology
• Secondary psoas abscess:enteric bacteria
– Escherichia coli
– Streptococcus species
– Enterobacter species
– Salmonella enteritidis
– Methicillin resistant S aureus
– Mycobacterium tuberculosis
– Nontuberculous mycobacteria
• M kansasii
• M xenopi

Clinical Features:Symptoms

Clinical Features:Symptoms
Nonspecific.
• fever
• flank pain
• abdominal pain
• Limp
• pain sometimes radiates anteriorly to the
hip and thigh.
• Other symptoms are nausea, malaise, and
weight loss.

Clinical Features:Signs

Clinical Features:Signs
 Posture- supine position, with the knee
moderately flexed and the hip mildly
externally rotated.
 Psoas sign passively extending the thigh of
a patient lying on his side with knees
extended, or asking the patient to actively
flex his thigh at the hip. If abdominal
pain results, it is a "positive psoas sign".
 Tender swelling below inguinal ligament.

Diagnostic Studies

Diagnostic Studies
• Laboratory Studies
• Imaging Studies

Diagnostic Studies
• Laboratory Studies
– Leukocytosis
– elevated erythrocyte sedimentation rate (ESR)
– elevated blood urea nitrogen (BUN)
– Pyuria

Diagnostic Studies
Imaging Studies
• USG
• CT
• Nuclear scan

Management

Management
• Appropriate antibiotics, as well as drainage
of the abscess.
• CT-guided percutaneous drainage or
surgical drainage

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