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Psoas Abscess

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Hasan Arafat
Hasan Arafat

This case report describes a 69-year-old woman who presented with right flank pain radiating to the groin, associated with fever and fatigue. Her medical history included a cholecystectomy complicated by bile peritonitis. On examination, she had a drain in her right flank draining pus. CT scan showed a distended right psoas muscle indicating an abscess. She underwent CT-guided drainage of the abscess, which was successful. Psoas abscesses are usually secondary to spread of infection from the digestive or urinary tract, but can also arise from hematogenous spread in immunocompromised individuals. Presentation is often vague with back pain, fever and fatigue.

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Case Report Psoas Abscess Husam Maqboul Hasan Arafat
Chief Complaint • A 69-year-old lady, was referred to our hospital complaining of right flank pain radiating to the groin • The pain was associated with fever (38.4 orally, measured at onset • The pain was also associated with nausea without vomiting and general fatigue, however, her fatigability did not keep her from attending her daughters wedding • Pain was exacerbated by extending the hip • The patient reported that her symptoms started as fever and cough 10 days ago, flank pain started in the 5th day
Past Medical History • The patient underwent cholecystectomy in 2006 in Qalqilya UNRWA hospital • She claimed that her gallbladder was still inflamed when the surgeon started the procedure • Post-op, the patient became feverish and jaundiced, she was referred to Augusta Victoria hospital-Jerusalem, where a T-drain was inserted to relieve her jaundice • The patient did not improve, so she was referred to Hadassah Medical Centre, where she underwent a repair procedure, the operation was successful • The patient was diagnosed with bile peritonitis caused by bile leak
O/E • The patient was lying on her left side in the bed • She looked tired and uncomfortable, she was alert • Her right hip was flexed • She had a drain the posterior side of her right flank with frank greenish pus in the urine bag • The abdomen was distended with no tenderness
Imaging • As you can see on the CT, the patient right psoas muscle is distended by a low-attenuation lesion,the lesion represents the abscess
Treatment • CT-guided percutaneous drainage: draining the abscess through the skin under CT, the procedure was successful
POD 1 • Heart rate: 96 • Blood pressure: 145/79 • Temperature: 36.9 orally • O2 SAT: 95 • Drain: 900 mL pus
Psoas Abscess • A.K.A retroperitoneal abscess • At the beginning of the 20th century, TB (Pott’s disease) was the most common cause • Nowadays, it is mostly secondary to direct spread of infection from an inflamed digestive/urinary tract • Perforation might/might not be present
Psoas Abscess • In recent years, a primary psoas abscess originating from an occult source via hematogenous spread became more common • This usually presents in the immunocompromised, elderly and IV drug abusers
Psoas Abscess • Presentation is usually vague, consisting of back pain, fever and fatigue (non-specific symptoms) • A swelling might be felt at the groin, it might simulate femoral hernia
My group after finishing our first rotation, it was OB/GYN. We took this photo in Tulkarem, 2 days before Eid Al-Adha (read about it). I am the dude at the far right (your right)

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Psoas Abscess

  • 1. Case Report Psoas Abscess Husam Maqboul Hasan Arafat
  • 2. Chief Complaint • A 69-year-old lady, was referred to our hospital complaining of right flank pain radiating to the groin • The pain was associated with fever (38.4 orally, measured at onset • The pain was also associated with nausea without vomiting and general fatigue, however, her fatigability did not keep her from attending her daughters wedding • Pain was exacerbated by extending the hip • The patient reported that her symptoms started as fever and cough 10 days ago, flank pain started in the 5th day
  • 3. Past Medical History • The patient underwent cholecystectomy in 2006 in Qalqilya UNRWA hospital • She claimed that her gallbladder was still inflamed when the surgeon started the procedure • Post-op, the patient became feverish and jaundiced, she was referred to Augusta Victoria hospital-Jerusalem, where a T-drain was inserted to relieve her jaundice • The patient did not improve, so she was referred to Hadassah Medical Centre, where she underwent a repair procedure, the operation was successful • The patient was diagnosed with bile peritonitis caused by bile leak
  • 4. O/E • The patient was lying on her left side in the bed • She looked tired and uncomfortable, she was alert • Her right hip was flexed • She had a drain the posterior side of her right flank with frank greenish pus in the urine bag • The abdomen was distended with no tenderness
  • 5. Imaging • As you can see on the CT, the patient right psoas muscle is distended by a low-attenuation lesion,the lesion represents the abscess
  • 6. Treatment • CT-guided percutaneous drainage: draining the abscess through the skin under CT, the procedure was successful
  • 7. POD 1 • Heart rate: 96 • Blood pressure: 145/79 • Temperature: 36.9 orally • O2 SAT: 95 • Drain: 900 mL pus
  • 8. Psoas Abscess • A.K.A retroperitoneal abscess • At the beginning of the 20th century, TB (Pott’s disease) was the most common cause • Nowadays, it is mostly secondary to direct spread of infection from an inflamed digestive/urinary tract • Perforation might/might not be present
  • 9. Psoas Abscess • In recent years, a primary psoas abscess originating from an occult source via hematogenous spread became more common • This usually presents in the immunocompromised, elderly and IV drug abusers
  • 10. Psoas Abscess • Presentation is usually vague, consisting of back pain, fever and fatigue (non-specific symptoms) • A swelling might be felt at the groin, it might simulate femoral hernia
  • 11. My group after finishing our first rotation, it was OB/GYN. We took this photo in Tulkarem, 2 days before Eid Al-Adha (read about it). I am the dude at the far right (your right)