Iliopsoas abscess: quick review

10 Jul

Iliopsoas abscesses are very rare, but the frequency of diagnosis has increased with increased use of CT.  This used to be more commonly a post-mortem diagnosis.

Risk factors include:

  • diabetes,
  • IV drug use,
  • HIV,
  • renal failure, 
  • other forms of immunosuppression

The abscess can also be secondary as a result of spread from local infection.

Risk factors for secondary abscesses include:

  • trauma,
  • instrumentation in the inguinal region, lumbar spine, or hip region.

Bony sites such as vertebrae are the most frequent contiguous infected site.  It has also been described in the setting of appendicitis, colorectal CA, ulcerative colitis, or following abdominal surgery.

They more commonly occur in males than females. Median age is 44-58 years old.

Signs and symptoms include:

  • back/flank pain, 
  • fever, 
  • inguinal mass, 
  • a limp, 
  • anorexia, 
  • weight loss.  
  • Pain with localization to the back, flank, or lower abdomen +/- radiation to the hip (present in 91% of cases)

Treatment includes drainage and antibiotics. 

Mortality approaches 100% if undiagnosed/untreated.

Submitted by W. Brooks.

Reference(s): uptodate.com: psoas abscess; picture

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