Images in Clinical Medicine
Staphylococcal Psoas Abscess
N Engl J Med 1998; 339:519August 20, 1998
- Article
Figure 1 A 42-year-old man with the acquired immunodeficiency syndrome was evaluated for cachexia, hepatosplenomegaly, and persistent fever that was unresponsive to therapy with a third-generation cephalosporin and vancomycin. He had no lumbosacral, perineal, or leg pain and no difficulty walking. He had not had any recent infections of the skin or other sites. His white-cell count was 5700 per cubic millimeter (79 percent neutrophils). Computed tomography (CT) of the abdomen after intravenous administration of radiographic contrast material revealed bilaterally enlarged psoas muscles (long arrows in Panel A) with hypodense centers and thin residual rims of normally attenuating tissue; the ureters are indicated by short arrows. The fluid collection was continuous across the midline in the lower thoracic region (Panel B). A peripheral lucent lesion was seen in the body of the 12th thoracic vertebra, consistent with the presence of vertebral osteomyelitis. CT-guided aspiration of the right psoas yielded 400 ml of purulent fluid and decompressed the abscess in that muscle. Culture of the fluid grew Staphylococcus aureus. Although the catheter was left in the right psoas for several days, the insertion of a separate drain was required to decompress the abscess on the left side. The site of entry of the organism was not identified.
Richard D. Huhn, M.D.
National Heart, Lung, and Blood Institute, Bethesda, MD 20892Harish P. Dave, M.D.
Washington Veterans Affairs Medical Center, Washington, DC 20422- Citing Articles (1)
Citing Articles
1
Vicente Navarro López, José M. Ramos, Victoria Meseguer, José Luis Pérez Arellano, Regino Serrano, Miguel Angel García Ordóñez, Galo Peralta, Vicente Boix, Javier Pardo, Alicia Conde, Fernando Salgado, Félix Gutiérrez. (2009) Microbiology and Outcome of Iliopsoas Abscess in 124 Patients. Medicine 88:2, 120-130
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