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Psoas abscess in children
Insights
Psoas abscess is often missed in children presenting with limps or abdominal pain. Early ultrasound or CT scans are crucial for diagnosis and surgical treatment, leading to full recovery.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Diagnostic Imaging
Background:
- Psoas abscess is an uncommon diagnosis in children, frequently overlooked in the differential for limp or abdominal pain.
- Delayed diagnosis can lead to prolonged investigations and specialist consultations.
Observation:
- Seven pediatric cases of psoas abscess, predominantly Staphylococcal, were surgically drained over seven years.
- Initial diagnoses were often septic arthritis of the hip, ruled out by negative hip aspirations and bone scans.
Findings:
- While gallium scans, IVPs, and barium enemas were suggestive, ultrasound and CT scans were definitive for surgical intervention.
- All surgically treated patients experienced improvement and recovered hip function.
Implications:
- Ultrasonography and computed tomography (CT) should be considered for children with hip pain or limp after hip pathology is excluded.
- Non-specific tests like gallium scans, IVPs, or barium enemas are insufficient to guide surgical decisions for suspected psoas abscess.
Abstract:
In children, psoas abscess does not head the list in the differential diagnosis of the child who presents with a limp or lower abdominal pain. Therefore, the road to this diagnosis can be long and complicated leading to numerous studies and specialty consultations. Over a 7-year period, seven psoas abscesses have been drained surgically. All were Staphylococcal though one was mixed. In each case, the original admitting diagnosis was that of septic arthritis of the hip. In general, this diagnosis was ruled out by negative hip aspirations and bone scans. Often, the severity of symptoms led to persistent evaluation with noninvasive tests such as gallium scan, intravenous pyelogram, or barium enema. Though these tests were often suggestive, a positive ultrasound or CT scan was the key studies diagnostic enough to warrant surgical exploration and drainage. During this time period, there have been no negative explorations for psoas abscess. Upon surgical drainage, all patients improved, with subsequent recovery of hip function. The child who presents with a limp or painful hip should be considered for ultrasonography or computerized tomography once hip pathology is ruled out. We feel that the results of other tests such as gallium scan, IVP, or barium enema are not sufficiently specific to indicate surgery.