Psoas Abscess

Question 1

What is a Psoas abscess

Answer 1

collection of pus on the psoas muscle

Question 2

How would a psoas abscess present?

Answer 2

Pain in the lumbar region worse on extension of the thigh or flexion at hip against resistance. Potentially fever and tachycardia. swelling in the groin may be present and or oedema in the upper leg. Relief when lying on back with flexed knees and increased pain when moving or weight bearing Background of IV user, TB or ileum enteritis in Crohns.
FEVER, BACK/FLANK PAIN, LIMP, WEIGHT LOSS

Question 3

What differentials for psoas abscess?

Answer 3

Vertebral osteiomyelitis (more common in young children or older adults), femoral hernia, enlarged lymph nodes

Question 4

common causative organism of a psoas abscess?

Answer 4

Staphylococcus or streptococcus

Question 5

Risk factors for psoas abscess?

Answer 5

Immune suppressed, Iv drug use, previous surgery, TB. Diverticulitis, Colorectal cancer, UTI, GU cancers endocarditis

Question 6

How to investigate and manage a psoas abscess?

Answer 6

Bloods fr septic screen and systemic inflammation. CT abdo if that’s the source of the abscess. Antibiotics +/- drainage. Manage risk factors

Question 7

How does vertebral osteomyelitis present

Answer 7

usually presents with fever, tenderness and swelling over the infected vertebrae and weakness of the surrounding muscles.

Question 8

Surgical management of psoas abscess

Answer 8

CT to plan approach - extraperitoneal approach important. Incision at level of L4 on affected side. performed under GA