This document discusses psoas abscess, which is an infection of the psoas muscle. It presents the key information about psoas abscess as follows: Psoas abscess can have an insidious onset and the classical triad of symptoms are fever, back pain, and limp. Examination may reveal swelling in the groin and pain with hip extension. Imaging such as ultrasound and CT scan can help identify the abscess and its cause. Etiology is typically primary from hematogenous spread in immunocompromised patients, or secondary from local spread of enteric or uropathogens. Treatment involves drainage either percutaneously or surgically along with culture-specific antibiotics and treatment of

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