Anatomy, etiology, presentation and management of Psoas Abscess

1. Psoas Abscess
Dr. Mudassir Hussain

2. Psoas Abscess
Perinephric Collection

3. Posterior abdominal wall
• Colon
• Appendix
• Aorta
• Pancreases
• Spine
• Kidneys
• Ureters

4. Retroperitoneum
Urologist’s Home

5. Presentation
Insidious onset
Classical triad
– Fever, Back Pain, Limp
• Flank pain radiating to
anterior thigh
• Fever
• Weight loss
• Nausea
• Swelling in Groin

6. Examination
• Ill looking emaciated patients
• Swelling in Groin
• Pain on extension of hip

7. Laboratory
• High TLC
• Raised ESR
• Raised CRP
• Abnormal blood sugars
• Raised Creatinine and urea
• Blood and Urine cultures

8. Imaging
• Ultrasound
– Diagnostic in 60 % cases
– Difficult to differentiate
Psoas abscess from
Perinephric collections

9. Imaging
• Plain X ray
– Loss of Psoas shadow

10. Imaging
• Cross sectional Imaging
– CT scan is the Imaging of
choice
– Help identify the cause

11. Etiology
Primary
• Rich blood supply of Psoas muscles predispose to
Hematogenous spread of organisms
• Immunocompromised states
– HIV, DM, IV drug abusers, Renal failure, Immunosupressive drugs
• Staph Aureus (80%)

12. Etiology
Secondary
Local spread
• Enteric bacteria (Polymicrobial)
– E. Coli
– Pseudomonas aeroginosa
– Streptococcus
– Enterobacter
• Uropathogens (monomicroial)
– E. Coli
• Tuberculous
– Mycobacterium

13. Treatment
Drainage
Percutaneous
Ultrasound Guided
CT Scan Guided
Open Surgical

14. Treatment
• Culture specific antibiotics
• Analgesics
• Nutritional optimization
• Mobilization
• Treatment of underlying cause

15. Take Home Message
Clinical Management
Starts from
History
Not Ultrasound

16. Thank You