A 37-year-old male painter presented with a painful lump in his left flank for two months with fever and general weakness. Examination found a tender lump in his left renal area without hip flexion deformity. Tests showed elevated white blood cells and C-reactive protein. Ultrasound found a thick-walled mass in the left renal area not connected to the kidney. CT scan later revealed a bulky left psoas muscle with an abscess extending into the abdominal wall and paraspinal region, displacing the left bowels medially. Surgical drainage was performed and antibiotics started. Microbiology later found the abscess was tuberculosis, so antitubercular treatment was added.

1. BY: Dr. Rekha Khare
MD RADIOLOGY

2.  A young man 37yr painter by occupation
came to medical out patient department
with painful lump in left flank for about two
months. There was history of low grade
pyrexia and constitutional symptoms

3.  Tender lump palpable in left renal fossa
 No significant hip flexion deformity

4.  Raised white blood count
 Raised C-reactive protein

5.  Thick walled complex echo mass in left renal
fossa not connected to left kidney
 Slightly thick psoas muscle with no fluid
 B/L renal/ureteric calculi with
hydronephrosis
 Moderate Hepatosplenomegaly

6. CT was done after 3 days of u/s exam
 Bulky left psoas muscle with collection in
muscular plane
 Left psoas breaking anterio-superiorly in to a
well enhanced huge thick walled multi-
loculated pocket
 Extension was noted laterally in superficial
abdominal wall
 Tiny abscess was also seen in left paraspinal
region

7.  Left sided bowels displaced medially
 B/L renal/ureteric calculi with moderate
hydronephrosis
 Moderate hepatosplenomegaly

8.  Left chronic psoas abscess (ruptured/
extension extraperitoneal)
 B/L hydronephrosis
( Rt ureteric and left renal calculus)

20.  Surgical drainage was done
 Broad spectrum antibiotics given
 Later on Anti tubercular treatment when
AAFB was found +ve in pus

21.  Case came for painful lump left abdomen
 Clinically no hip flexion, an important sign in
favor of psoas abscess
 Initial U/S showed no communication
between lump and psoas muscle

22.  Sometimes it is difficult to identify psoas
abscess on first visit
 Repeated appropriate imaging should be
considered if initial imaging is not
compatible with clinical presentation
 Microbiology of psoas abscess varies with
geography. In endemic area abscess may be
secondary to Mycobactrium Tuberculosis

23.  Unusual presentation of psoas abscess in a
child.
J pediatr surg. 2001Dec.36(12)1859-60
Ixheimer O. Cohen Z. Barki Y. Marks A. J
 Case report: Psoas abscess- unusual
etiology of Groin pain
Med Gen Med. 2005,7(3):10Manoj Todkar

24.  An unusual case of a psoas abscess.
Irshad W. Gupta S. Katz A
Deptt of Medicine ohn H Stroger Jr
Hospital of Cook County Chicago