Clinical Presentations, Diagnosis, and Treatments of a Psoas Abscess

Park,  Chang Bae; Kim,  Kyu Seok; Shin,  Jung Ho; Suh,  Gil Joon; Youn,  Yeo Kyu

J Korean Soc Emerg Med > Volume 16(3); 2005 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2005;16(3): 346-351.

Clinical Presentations, Diagnosis, and Treatments of a Psoas Abscess

Chang Bae Park, Kyu Seok Kim, Jung Ho Shin, Gil Joon Suh, Yeo Kyu Youn

¹Department of Emergency Medicine, Seoul National University, College of Medicine, Seoul, Korea. suhgil@snu.ac.kr
²Department of General Surgery, Seoul National University, College of Medicine, Seoul, Korea.

ABSTRACT

PURPOSE:
A psoas abscess is a rare, but life-threatening disease. We report 11 cases of a psoas abscess in adults and discuss its clinical presentations, diagnosis, and treatments.
METHODS:
Retrospective analysis of patients who presented to the emergency department with a psoas abscess from Jan. 2000 to Aug. 2004 was conducted.
RESULTS:
Of the 11 patients with a psoas abscess, 9 (81.8%) had a secondary psoas abscess. The most common causes of the secondary psoas abscess were various invasive procedures, such as acupuncture, a nerve block, etc. The main clinical presentations were fever (72.7%) and back pain (45.5%). The mean time to presentation was 12.0+/-10.6 days. All patients had leukocytosis and elevated CRP. Computed tomography (81.8%) and magnetic resonance imaging (18.2%) were performed for the diagnosis. The mean diagnostic lag time (from admission to the treatment) was 7.8+/-7.5 days. All patients received intravenous antibiotics. Four patients (36.4%) underwent surgical drainage, and three patients (27.3%) underwent percutaneous drainage. Two patients (18.2%) were treated with simple aspiration, and another two (18.2%) received no procedure. Six patients (54.5%) had complications. Three (27.3%) had a recurrent abscess, and two (18.2%) had a epidural abscess. In one patient, femoral neuropathy developed. The time from clinical presentation to diagnosis in the complication associated group was longer than it was in complication non-associated group (27.5+/-19.6 vs 10.6+/-3.2 days, p=0.03).
CONCLUSION:
A psoas abscess is difficult to diagnose because of vague clinical symptoms and can have serious complications if the diagnosis is missed or delayed.

Key words: Psoas abscess