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Primary psoas abscess--diagnostic and therapeutic considerations
1Department of Urology, Institution Medical College, Kerala, India.
Objective:
To present our experience of the diagnosis and treatment of primary psoas abscess in India.
Patients And Methods:
Between July 1993 and December 1995, five men (aged 24-67 years) presented with suspected primary psoas abscess. All five patients had fever with or without rigors and upper/lower abdominal pain of varying duration (2-6 weeks).
Results:
The presentation in all patients was conspicuous by the absence of the classical signs of limping and positive psoas symptoms. Computed tomography (CT) was the best method of diagnosis, being accurate in every case. Antibiotics alone (two patients), or in combination with percutaneous aspiration, were curative.
Conclusions:
This small series of five patients of primary psoas abscess was remarkable in that all the patients were men and three were elderly. The classical symptom of limping was absent in all. The urologist can be misled by loin pain and irritative lower urinary symptoms in the patients, resulting in a delay in diagnosis and management.
Insights
Primary psoas abscesses in India predominantly affect men and often lack typical symptoms like limping. Computed tomography (CT) is crucial for diagnosis, with antibiotics and aspiration proving effective treatments.
Area of Science:
- Medical Science
- Infectious Diseases
- Surgical Pathology
Background:
- Primary psoas abscess is a rare condition.
- Diagnosis can be challenging due to atypical presentations.
Purpose of the Study:
- To describe the experience with primary psoas abscess diagnosis and treatment in India.
- To highlight diagnostic challenges and effective management strategies.
Main Methods:
- Retrospective case series of five male patients diagnosed with primary psoas abscess between July 1993 and December 1995.
- Clinical presentation, diagnostic methods (including Computed Tomography - CT), and treatment outcomes were analyzed.
Main Results:
- All five patients were male, with three being elderly.
- Common symptoms included fever and abdominal pain; classical signs like limping were absent.
- Computed tomography (CT) demonstrated high accuracy for diagnosis.
- Treatment with antibiotics alone or combined with percutaneous aspiration was curative.
Conclusions:
- Primary psoas abscess in this series predominantly affected men and presented without classical symptoms.
- The absence of limping and presence of loin pain can mislead urologists, delaying diagnosis.
- CT imaging is essential for accurate diagnosis, and non-surgical treatments are effective.