Beyond the psoas: iliopsoas abscess with thigh extension successfully managed by percutaneous approach

Iliopsoas abscess is an uncommon but potentially life-threatening condition. Distal extension into the thigh is extremely rare and usually requires surgery. We report the case of a 65-year-old woman presenting with fever, back pain, and impaired hip mobility. Contrast-enhanced computed tomography revealed a multiloculated iliopsoas abscess extending into the thigh adductor compartment. Under combined ultrasound and fluoroscopic guidance, multi-access percutaneous drainage was performed using one retroperitoneal and two femoral catheters, yielding purulent material positive for Staphylococcus aureus. Targeted antibiotic therapy and serial catheter lavages led to rapid recovery. Drains were removed after 14 days, and the patient remained symptom-free at 3-month follow-up. This case demonstrates that even complex iliopsoas abscesses with thigh extension can be successfully treated with a tailored image-guided percutaneous approach, providing a safe and effective alternative to open surgery in selected cases.