Psoas muscle abscess

Dr Ayush Goel and Dr Saeed Soltany Hosn et al.

Psoas muscle abscess and fluid collections are located in the retrofascial
space rather than in the retroperitoneal space because the psoas muscles are
located in the iliopsoas compartment posterior to the transversalis fascia,
which is the posterior boundary of the retroperitoneum.

Clinical presentation
Psoas muscle abscess may present with fever, flank pain, abdominal pain or
limp. Other symptoms are nausea, malaise and weight loss.

Pathology
Psoas muscle abscess may be classified as primary or secondary depending
on the presence or absence of underlying disease.

Primary
Primary psoas muscle abscess occurs probably as a result of haematogenous
spread of an infectious process from an occult source in the body. Primary
psoas muscle abscess can occur in patients with:

diabetes mellitus

intravenous drug abuse

AIDS

renal failure

immunosuppression

Secondary
Spread of infection from gastrointestinal disease
(e.g. appendicitis, diverticulitis, Crohn's disease or perforated colon
carcinoma) is the most common source of a
secondary psoas muscle fluid collection.
Renal disease is the second most common source.
They may also occur as a result of a neighbouring spondylodiscitis.

Radiographic features
CT/MRI

Cross-sectional imaging is the method of choice for abscess detection.

Ultrasonography
It is diagnostic in only 60% of cases of psoas abscess, compared with 80% to
100% for CT.

Treatment and prognosis

Appropriate antibiotics along with drainage of the abscess is the treatment of
choice. This is often treated with a image guided percutaneous drainage,
typically CT, due to the retroperitoneal location.

Differential diagnosis

psoas muscle haematoma