Iliopsoas abscess

Question 1

What is an iliopsoas abscess?

Answer 1

collection of pus in iliopsoas compartment (between iliopsoas and iliacus muscles)

Question 2

Primary cause of iliopsoas abscess

Answer 2

Haematogeneous spread

Question 3

In an iliopsoas abscess caused by primary haematogeneous spread, what bug is most commonly isolated?

Answer 3

Staphylococcus aureus

Question 4

What conditions can cause a secondary iliopsoas abscess

Answer 4

Crohn’s
Diverticulitis
colorectal cancer
UTI
Genitourinary cancers
Vertebral osteomyelitis
Femoral catheter
lithotripsy
Endocarditis
IVDU

Question 5

Clinical features of iliopsoas abscess

Answer 5

Fever
Back/flank pain
Limp
Weight loss

Question 6

how is the patient normally lying when you go to examine them if they have an iliopsoas abscess

Answer 6

• Patient supine with knee flexed and the hip mildly externally rotated

Question 7

Specific tests to diagnose iliopsoas inflammation

Answer 7

• straight leg raise on affected side will be painful due to
  contraction of the psoas muscle.
• Lie patient on unaffected side and hyperextend the affected hip. This should elicit pain as the psoas muscle is stretched.

Question 8

Imaging modality of choice to diagnose iliopsoas absess

Answer 8

CT abdomen

Question 9

Management of iliopsoas abscess

Answer 9

• Antibiotics
• Percutaneous drainage
• Surgery if:
  1. Failed percutaneous drainage
  2. Presence of an another intra-abdominal pathology which requires surgery