Psoas abscess: making an early diagnosis in the ED

Area of Science:

• Emergency Medicine
• Radiology
• Infectious Disease

Background:

• Psoas abscess presents variably and infrequently in the emergency department (ED), often leading to delayed diagnosis or misdiagnosis.
• Limited research exists on diagnostic challenges of psoas abscess from the emergency physician (EP) perspective, particularly with advanced imaging like ultrasonography.

Purpose of the Study:

• To evaluate the role and diagnostic utility of emergency physicians (EPs) and ultrasonography in diagnosing psoas abscess within the emergency department (ED).
• To analyze the diagnostic experience and outcomes of patients with psoas abscess treated in the ED.

Main Methods:

• Retrospective review of 10 patients diagnosed with psoas abscess in the ED over a 1-year period (November 1993-October 1994).
• Analysis of presenting symptoms, diagnostic methods (ultrasound, CT, surgery), initial ED diagnoses, and patient outcomes.
• Focus on diagnoses made by EPs using ultrasonography.

Main Results:

• Psoas abscess was diagnosed in the ED in 7 out of 10 patients.
• Pain (80%) and flank pain (50%) were common symptoms; the classic triad was present in only 30% of patients.
• Ultrasonography performed by EPs was crucial in diagnosing 4 patients with sepsis and non-specific symptoms, leading to earlier intervention.

Conclusions:

• Emergency physicians' alertness and expertise in ultrasonography can facilitate early diagnosis and drainage of psoas abscess.
• Screening ultrasound in patients with unexplained sepsis or prolonged fever should include the peritoneal and retroperitoneal spaces.
• A flowchart is presented to aid in the diagnosis of psoas abscess in the ED setting.