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.
Source: PubMed


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.
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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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