A rare cause of flank mass: psoas abscess due to extensive primary thoracolumbar tuberculous spondylodiskitis

Department of Radiology, Gulhane Military Medical School, 06018, Etlik, Ankara, Turkey.
American Journal of Neuroradiology (Impact Factor: 3.59). 10/2006; 27(8):1735-7.
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Psoas abscess secondary to tuberculous spondylodiskitis is usually a complication of thoracolumbar vertebrae disease. The psoas abscess may be difficult clinically to diagnose because of its rarity, insidious onset of the disease, and nonspecific clinical presentation. We report multidetector CT and MR imaging findings of a psoas abscess secondary to primary tuberculous spondylodiskitis of the spine from the T3 to L2 vertebrae, which presented as a flank mass.

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Available from: Murat Kocaoglu, Jan 22, 2015
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    • "This is not the first case in the medical literature in which the psoas abscess presented as a flank or buttock mass. Mycobacterial [3, 19] or pyogenic [9] infection of the psoas muscle has been reported to propagate to the retroperitoneum or flank/buttock through the abdominal wall. Psoas abscess and cellulitis of the right gluteal region resulting from retroperitoneal perforation of cecum carcinoma has also been reported [22]. "
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    ABSTRACT: Buttock abscess is a rare clinical manifestation from unusual extrapelvic extension of psoas abscess. A 48-year-old woman presented with painful swelling of the buttock with a sense of local heat. Magnetic resonance imaging revealed a large subfascial abscess over the glutei muscles and was traced into the intraabdominal cavity over the iliac wing to the psoas muscle. Both the psoas abscess and the buttock abscess were evacuated via separate approaches. Empirical antibiotic therapy was delivered for 3weeks. After 6months, no evidence of recurrence was found. Psoas abscess could be included in the differential diagnosis of buttock abscess.
    Journal of Orthopaedics and Traumatology 12/2009; 10(4):207-210. DOI:10.1007/s10195-009-0074-2
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    ABSTRACT: A tuberculous psoas abscess is a frequently described complication of tuberculous spondylitis. Although rare, a tuberculous psoas abscess can develop without any demonstrable spinal involvement. In patients with no evidence of sponylitis, the abscess may result from direct spread from the involved lymph node or via a hematogeous route. The treatment of a psoas abscess is either drug therapy or surgical intervention in conjunction with drug therapy. Image-guided percutaneous drainage in conjunction with drug therapy is also a safe and effective treatment for a tuberculous psoas abscess. We report an unusual case of bilateral tuberculous psoas abscesses without any concomitant spinal involvement. The tuberculous psoas abscess may have formed by fistulization between the necrotic lymph node and psoas sheath. The diagnosis was confirmed by computed tomography and a histology examination of the biopsy sample. The patient improved after administering anti-tuberculous agents for 2 years along with surgical and percutaneous drainage of the abscess.
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    ABSTRACT: Review of historical archival records. Describe Harvey Cushing's patients with spinal pathology. Harvey Cushing was a pioneer of modern surgery but his work on spine remains largely unknown. Review of the Chesney Medical Archives of the Johns Hopkins Hospital from 1896 to 1912. This is the first time that Cushing's spinal cases while he was at the Johns Hopkins Hospital, including those with Pott disease, have been described.Cushing treated three young men with psoas abscesses secondary to Pott disease during his residency: he drained the abscesses, debrided any accompanying necrotic vertebral bodies, irrigated the cavity with salt, and left the incision open to close by secondary intention. Although Cushing used Koch's "tuberculin therapy" (of intravenous administration of isolated tubercular bacilli) in one patient, he did not do so in the other two, likely because of the poor response of this first patient. Later in his tenure, Cushing performed a laminectomy on a patient with kyphosis and paraplegia secondary to Pott disease. These cases provide a view of Cushing early in his career, pointing to the extraordinary degree of independence that he had during his residency under William Steward Halsted; these cases may have been important in the surgical upbringing both of Cushing and his coresident, William Stevenson Baer, who became the first professor of Orthopedics at Johns Hopkins Hospital. At the turn of the last century, Pott disease was primarily treated by immobilization with bed rest, braces, and plaster-of-paris jackets; some surgeons also employed gradual correction of the deformity by hyperextension. Patients who failed a trial of conservative therapy (of months to years) were treated with a laminectomy. However, the limitations of these strategies led to the development of techniques that form the basis of contemporary spine surgery-instrumentation and fusion.
    Spine 08/2011; 36(17):1420-5. DOI:10.1097/BRS.0b013e3181f2a2c6 · 2.30 Impact Factor
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