RESUMO
INTRODUCTION: Psoas abscess is a rare pathological entity being retroperitonescopy an unusual therapeutic modality for its resolution. MATERIALS AND METHODS: The objective is to present and describe five patients with a diagnosis of psoas abscess that were resolved by retroperitoneoscopy in our institution and then carried out a non-systematic review of the literature. RESULTS: The mean age was 58.8 years and 80% were male. All patients had back pain and none had therapeutic resolution with conservative treatment. 60% of the patients had a methicillin sensitive Staphyylococus Aureus. In the follow-up with a mean of 10.2 months, no recurrence was observed. CONCLUSIONS: Early diagnosis of psoas abscess is important for its correct resolution. In our small series of patients, retroperitoneoscopy was an effective treatment.
Assuntos
Laparoscopia , Abscesso do Psoas , Humanos , Masculino , Pessoa de Meia-Idade , Feminino , Abscesso do Psoas/cirurgia , Abscesso do Psoas/diagnóstico , Abscesso do Psoas/etiologia , Espaço Retroperitoneal/patologia , Resultado do Tratamento , Tomografia Computadorizada por Raios X/efeitos adversosRESUMO
Los abscesos del psoas ilíaco secundarios a un tumor de colon fistulizado son excepcionales y potencialmente graves. La mayoría son adenocarcinomas de tipo mucinoso. Su tratamiento es complejo ya que, para lograr una resección oncológica pretendidamente curativa, es necesario realizar una resección ampliada con mayor morbimortalidad. Presentamos el caso de una paciente con un adenocarcinoma mucinoso de colon izquierdo fistulizado al músculo ilíaco y la pared anterolateral del abdomen en la que se realizó una resección multivisceral que incluyó el colon izquierdo, el músculo y la cresta ilíaca y parte de la pared anterolateral del abdomen.
Iliopsoas abscess secondary to perforation of colon cancer is an extremely rare and potentially life-threatening condition. Most tumors are mucinous adenocarcinomas. Its treatment its complex, as most patients need radical extended resections to achieve good oncological results, which are in turn, graved with higher morbidity and mortality. We present the case of a patient with a left colon mucinous adenocarcinoma penetrating to the iliopsoas muscle and the anterolateral abdominal wall that required a multivisceral resection including left colon, iliac muscle and crest and part of the anterolateral abdominal wall.
Abscessos do iliopsoas secundários a um tumor de cólon fistulizado são raros e potencialmente graves. A maioria são adenocarcinomas do tipo mucinoso. Seu tratamento é complexo, pois, para se obter uma ressecção oncológica supostamente curativa, é necessário realizar uma ressecção ampliada com maior morbimortalidade. Apresentamos o caso de um paciente com adenocarcinoma mucinoso de cólon esquerdo fistulizado para o músculo ilíaco e parede ântero-lateral do abdome no qual foi realizada ressecção multivisceral que incluiu cólon esquerdo, músculo e crista ilíaca e parte do a parede anterolateral do abdome.
Assuntos
Feminino , Pessoa de Meia-Idade , Neoplasias do Colo/cirurgia , Adenocarcinoma Mucinoso/cirurgia , Fístula Intestinal/etiologia , Abscesso do Psoas/etiologia , Colectomia , Neoplasias do Colo/complicações , Neoplasias do Colo/diagnóstico por imagem , Adenocarcinoma Mucinoso/complicações , Parede Abdominal/patologia , Ílio/patologiaRESUMO
Antecedentes: el absceso del psoas ilÃaco es una entidad poco frecuente y de etiologÃa variable. Su ubicación y cuadro clÃnico inespecÃfico la convierte en una entidad de difÃcil diagnóstico para el cirujano general. La oportunidad de tratar una serie de casos en un perÃodo de tiempo relativamente corto para este tipo de patologÃa motivan esta comunicación. Objetivo: a partir de una serie consecutiva de casos, analizar etiologÃa, clÃnica, y enfoque diagnóstico terapéutico, con especial énfasis en el drenaje percutáneo , como asà también una sucinta revisión de la bibliografÃa reciente. Material y métodos: estudio observacional retrospectivo de una serie consecutiva de casos Resultados: la serie consta de 6 casos, 5 de tipo primario y 1 de tipo secundario. La signos más frecuentes fueron el dolor, la impotencia funcional y la leucocitosis. La TomografÃa axial computada de abdomen con y sin contraste fue el método diagnóstico de elección. El drenaje percutáneo fue el tratamiento de elección en 5 casos (83,3%) mientras que en el restante se optó por antibioticoterapia y el drenaje de una colección adyacente. La evolución de todos los casos fue favorable. Conclusión: el absceso de psoas ilÃaco es una patologÃa que necesita un alto nivel de sospecha dada su clÃnica inespecÃfica. Para su diagnóstico, junto acon la clÃnica la TomografÃa es el método de elección. El drenaje percutáneo de las colecciones bajo control tomográfico es un opción segura y eficaz para el tratamiento de esta entidad.
Background: The of the iliopsoas abscess is a rare entity with a variable etiology. Its location and nonspecific clinical features makes it becomes a diagnostic and therapeutic challenge for the general surgeon. The opportunity to treat a series of cases in a relatively short period of time motivates this communication. Objective: From a consecutive case series, we analyze etiology, clinical features , as well as diagnostic and therapeutic approaches, with special emphasis on percutaneous drainage, as well as a brief review of recent literature. Material and methods: Retrospective analysis of a consecutive series of six patients diagnosed with an ilipsoas abscess in a tertiary care center. Results: The series consists of 6 cases, 5 of primary type and 1 of secondary type. Pain, Limp and leucocitosis were the more prevalent signs; computed tomography of the abdomen was the diagnostic method of choice. Percutaneous drainage was the therapeutic option in 5 cases (83.3%), while in the remaining, antibiotic therapy and the drainage of an adjacent collection were indicated. The evolution of all cases was favorable with no mortality nor morbidity. Conclusion: The iliac psoas abscess is a pathology that needs a high level of suspicion given its nonspecific presentation. For diagnosis, together with the clinic, computed tomography is the method of choice. Percutaneous drainage of collection under tomographic control is a safe and effective option for the treatment of this entity.
Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Abscesso do Psoas/diagnóstico , Abscesso do Psoas/etiologia , Abscesso do Psoas/tratamento farmacológico , Argentina/epidemiologia , Administração Cutânea , Tomografia Computadorizada por Raios X/métodos , Drenagem , Estudos Retrospectivos , Ultrassonografia/métodosRESUMO
El absceso de músculo psoas iliaco se considera una rare-za. Su detección ha mejorado con la utilización de imágenes como la tomografía computada o la resonancia magnética. Presentamos una revisión de casos de absceso de psoas-iliaco internados entre julio de 2015 y febrero de 2018 en un hospital de CABA, Argentina.En este periodo se diagnosticaron un paciente conside-rado de origen primario y ocho de origen secundario. Se observó predominio de colecciones asociadas a es-pondilodiscitis. El síntoma más frecuente fue la fiebre. Staphylococcus aureus fue el germen más rescatado en muestras microbiológicas. Se debe tener alto índice de sospecha de esta patología ante la presencia de fiebre, dolor lumbar y en ocasiones alteración de la marcha. El empleo de antibióticos de amplio espectro sumado a la evacuación de colecciones constituyen la estrategia más efectiva
Psoas-iliac muscle abscess is considered a rarity, the use of images such as computed tomography or magnetic reso-nance imaging has improved its detection.This study reviews cases of psoas-iliac abscess in hospi-talized patients between July 2015 and February 2018 in a hospital in CABA, Argentina.In one of the patients the origin was considered primary ,while in the other eight it was secondary. There was a pre-dominance of collections associated with spondylodiscitis. The most frequent symptom was fever. Staphylococcus au-reus was the most frequent organism obtained in microbio-logical samples. A high level of suspicion must be held in the presence of fever, lumbar pain and sometimes alteration of the gait. The use of broad spectrum antibiotics in addition to evacuation of collections is the most effective strategy.
Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Infecções Estafilocócicas/terapia , Músculos Psoas/patologia , Abscesso do Psoas/diagnóstico , Abscesso do Psoas/etiologia , Abscesso do Psoas/terapia , Staphylococcus aureus Resistente à Meticilina , Antibacterianos/uso terapêuticoRESUMO
Introducción: El absceso del psoas es un cuadro infrecuente cuyo principal agente etiológico es el Staphyloccocus aureus, y que con baja frecuencia puede ser de etiología tuberculosa como complicación de una afección vertebral por Mycobacterium tuberculosis. Presentación del caso: Mujer de 58 años, mapuche, con antecedentes de enfermedad pulmonar obstructiva crónica y alcoholismo crónico, consultó por cuadro de dos meses de evolución de dolor lumbar, baja de peso y paresia de extremidad inferior derecha que impedía la marcha. Tomografía computada (TC) de columna evidenció espondilodiscitis y absceso del psoas derecho, iniciándose tratamiento antibiótico cubriendo Staphyloccocus aureus. Los hemocultivos y los cultivos de la colección resultaron negativos por lo que se decidió mantener tratamiento ambulatorio. Paciente consultó cuatro meses después por exacerbación de su disnea basal de dos semanas de evolución, radiografía de tórax y TC de tórax de alta resolución compatibles con tuberculosis pulmonar con diseminación miliar bilateral, por lo cual, se inició tratamiento antituberculoso, realizándose baciloscopías que resultaron negativas. Además, se solicitó identificación del bacilo de Koch mediante reacción de polimerasa en cadena que resultó positiva, con lo que se confirmó el diagnóstico de tuberculosis miliar y mal de Pott. Se decidió reevaluar con TC de columna una vez finalizado el tratamiento antituberculoso para decidir conducta quirúrgica. Discusión: Es importante la sospecha activa de etiología tuberculosa ante una espondilodiscitis y un absceso del psoas, pese a su baja frecuencia. El inicio del tratamiento en forma precoz puede modificar la progresión de una infección que puede ser invalidante e incluso mortal.
Introduction: The Psoas abscess is an infrecuent condition which main ethiology is the Staphyloccocus aureus and with less frequency can be a vertebral tuberculosis complication caused by Mycobacterium tuberculosis. Case Report: a 58 years old female, Mapuche, with Chronic Obstructive Pulmonar Disease and chronic alcoholism antecedents, was admitted in the emergency room with a two month old lumbar pain, loss of weight and right inferior extremity paresia which didn't allowed her to walk. The column's Computed Tomography (CT) showed spondylodiscitis and a right psoas abscess, the antibiotherapy, covering Staphyloccocus aureus, was started. The hemoculives and abscess' cultives were negative, so it was decided to continue with ambulatory treatment. The patient was admitted four month later because of two weeks of exacerbation of her basal dysnea. The thorax Radiography and high resolution CT were compatibles with pulmonary tuberculosis with bilateral miliar disemination. Antituberculosis treatment was started, bacilloscopies were negative, also, a Polymerase Chain Reaction identification of Koch's bacillus was performed, resulting positive, confirming the diagnosis of miliar tuberculosis and Pott's disease. Once antituberculosis treatment was finished, a new column's CT was requested to decided surgical conduct. Discussion: Is important to actively suspect of tuberculosis ethiology in presence of spondylodiscitis and psoas abscess, despite it's low frequency. The early treatment start may modify the progresion of an infección that can be invalidating and even mortal.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Tuberculose da Coluna Vertebral/complicações , Tuberculose da Coluna Vertebral/tratamento farmacológico , Abscesso do Psoas/etiologia , Abscesso do Psoas/diagnóstico por imagem , Tuberculose/complicações , Tuberculose da Coluna Vertebral/etiologia , Radiografia Torácica , Discite , Tomografia Computadorizada por Raios X , Abscesso do Psoas/tratamento farmacológicoRESUMO
O abscesso do psoas traduz uma situação rara, de etiologia variada e fisiopatologia complexa, mas ainda não clarificada. O objetivo deste estudo foi relatar um caso de apresentação rara de abscesso do psoas sob a forma de derrame pleural. Paciente do sexo masculino, 63 anos, com quadro de dispneia e deterioração do estado geral, associado à febre (38,3ºC). Apresentava perda ponderal de 10kg, taquipneia e semiologia pulmonar compatível com derrame pleural direito. Os dados laboratoriais revelaram leucocitose associada à alteração da função hepática, proteína C-reativa e velocidade de sedimentação elevadas. Radiografia do tórax revelou derrame pleural direito. A tomografia computadorizada confirmou a presença de derrame pleural e de abscesso do psoas homolateral, tendo sido iniciada antibioterapia empírica com piperacilina/tazobactam e metronidazol. Realizou, posteriormente, drenagem guiada por tomografia computadorizada do abscesso do psoas. O exame cultural foi positivo para Streptococcus anginosus no líquido pleural, abscesso do psoas e sangue. Após drenagem de abcesso do psoas, foi mantida a imagem compatível com derrame pleural, tendo sido realizada nova drenagem torácica do derrame pleural. Após vários dias, retirou-se a drenagem torácica. Obteve alta hospitalar sendo referenciado à consulta de medicina. Devido à originalidade do caso, visto não existirem casos descritos com essa forma de apresentação, nem por esse agente etiológico, realizou-se uma revisão da literatura do diagnóstico e tratamento dessa doença.
Psoas abscess represents a rare situation of varied etiology and complex pathophysiology that has not yet been clarified. This study aimed to report an unusual presentation of psoas abscesso in the form of pleural effusion. Male patient, 63 years old, with signs of dyspnea and deterioration of general condition, associated with fever (100,94ºF). He presented with 10-kg weight loss, tachypnea, and pulmonary symptomatology that was consistent with right pleural effusion. Laboratory data showed leukocytosis with alteration of liver function, elevated C-reactive protein, and high erythrocyte sedimentation rate. Chest radiograph revealed right pleural effusion. Computed tomography confirmed the presence of pleural effusion and ipsilateral psoas abscess. Empirical antibiotic therapy with piperacillin/tazobactam and metronidazole was initiated, and computed tomography-guided drainage of the psoas abscess was performed. Culture was positive for Streptococcus anginosus in pleural fluid, psoas abscess and blood. After drainage of the psoas abscess, the image that was consistent with pleural effusion remained, and new chest drainage of pleural effusion has been held. After several days, the chest tube was removed. The patient was discharged and referred to clinical consultation. Because of the originality of the case, since there are no cases describing this presentation nor these etiologic agent, literature review of the diagnosis and treatment of this pathology has been conducted
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pleural/diagnóstico , Abscesso do Psoas/terapia , Streptococcus anginosus , Derrame Pleural/complicações , Abscesso do Psoas/etiologiaRESUMO
Spinal tuberculosis is the most common manifestation of extra-pulmonary tuberculosis. It is difficult to diagnose the disease due to its insidious onset and non-specific clinical presentation. A high degree of suspicion and appropriate imaging studies are necessary for its early diagnosis and treatment. The authors report a case of lumbosacral tuberculosis in an adult patient presenting with hip pain and abscesses.
Assuntos
Vértebras Lombares , Abscesso do Psoas/etiologia , Sacro , Tuberculose da Coluna Vertebral/complicações , Adulto , Biópsia , Diagnóstico Diferencial , Humanos , Masculino , Mycobacterium tuberculosis/isolamento & purificação , Abscesso do Psoas/diagnóstico , Abscesso do Psoas/microbiologia , Tomografia Computadorizada por Raios X , Tuberculose da Coluna Vertebral/diagnósticoRESUMO
OBJECTIVE: This study aimed to report the case of a patient who developed an iliopsoas abscess after a dilation and evacuation for a midtrimester fetal demise. MATERIALS AND METHODS: This is a case report of a 35-year-old woman who underwent a dilation and evacuation at 17 weeks' gestation because of a preterm premature rupture of membranes and fetal demise. Four days later, she presented with fevers, chills, malaise, and right lower back, hip, and thigh pain. Magnetic resonance imaging of the abdomen and pelvis revealed a 2.3 × 1.6-cm right iliopsoas abscess. RESULTS: The patient underwent computed tomography-guided drainage of the abscess and made an uneventful recovery after completion of an antibiotic course and physical therapy. CONCLUSIONS: An iliopsoas abscess should be considered in the differential diagnosis of any woman presenting with fevers, chills, and unilateral lower back, hip, and thigh pain in a radicular pattern after a recent dilation and evacuation.
Assuntos
Dilatação e Curetagem/efeitos adversos , Ruptura Prematura de Membranas Fetais/terapia , Abscesso do Psoas/diagnóstico , Abscesso do Psoas/patologia , Adulto , Drenagem , Feminino , Humanos , Imageamento por Ressonância Magnética , Pelve/diagnóstico por imagem , Gravidez , Abscesso do Psoas/etiologia , Abscesso do Psoas/cirurgia , Radiografia Abdominal , Resultado do TratamentoRESUMO
INTRODUCCIÓN: El absceso del psoas (AP) es una patología infrecuente de difícil diagnóstico. Se clasifica en primario o secundario teniendo como factor de riesgo común la inmunodeficiencia. PRESENTACIÓN DEL CASO: Paciente masculino de 40 años sin antecedentes mórbidos. Consulta por cuadro de un mes de evolución caracterizado por dolor lumbar derecho que aumenta al flexionar el muslo ipsilateral. Se asocia compromiso del estado general, dolor abdominal, sensación febril no cuantificada y bradipsiquia. La Tomografía computada (TC) de abdomen y pelvis mostró hipodensidad en relación al músculo psoas derecho diagnosticándose AP primario. El paciente evoluciona con shock séptico, siendo manejado con antibióticos de amplio espectro sin mejoría. Se realizan exámenes generales, Punción lumbar (PL) y Test de Elisa para VIH (TEVIH), resultando la PL compatible con Tuberculosis meníngea y el TE positivo. Se inició tratamiento empírico anti-tísico en espera del cultivo de Koch. Paciente evoluciona favorablemente. Se realiza una TC de control luego de dos semanas de tratamiento, que muestra imagen similar a la inicial, agregándose compromiso vertebral L4-L5, diagnosticándose Enfermedad de Pott (EP) y AP secundario. Se realiza punción y drenaje del absceso y se toma cultivo de Koch que resulta positivo. Paciente evoluciona asintomático, con buena respuesta al tratamiento. DISCUSIÓN: El AP secundario a EP es una entidad poco sospechada. Sin embargo, con métodos diagnósticos como la TC es posible realizar un diagnóstico precoz. Mycobacterium tuberculosis es una causa infrecuente de abscesos del psoas, pero debido al aumento de la población VIH positiva, es probable que aumente su incidencia.
INTRODUCTION: Psoas abscess is an uncommon disease with difficult diagnosis. It can be primary or secondary; immunodeficiency is among risk factors. CASE REPORT: 40 year-old male with no past medical history. He presented to the emergency department with right lumbar pain worsened with flexion of ipsilateral thigh. Involvement of general condition, abdominal pain, unquantified fever and bradypsychia were also present. Computed tomography (CT) scan of the abdomen and pelvis showed an hypodense lesion in the right psoas muscle. Primary psoas abscess was first diagnostic impression. Patient evolved to septic shock and was treated with broad spectrum antibiotics without improvement. General examinations were performed, lumbar puncture supported meningeal tuberculosis and HIV ELISA test was positive. Empirical quintuple therapy for tuberculosis was started before cerebrospinal fluid culture results, with favorable clinical evolution. Control CT scan was similar compared to first one but with L4 L5 vertebrae involvement. Pott disease and secondary psoas abscess was diagnosed. Kochs Bacillus culture from abscess puncture were positive. Patient had clinical improvement with antituberculous therapy. DISCUSSION: Psoas abscess is a rarely suspected patology, but with diagnostic methods as CT is possible to make an early diagnosis. Even though Mycobacterium tuberculosis is a rarer cause of psoas abscess, but more cases are expected due to the increased incidence of HIV positive patients, more cases are expected eventually.
Assuntos
Humanos , Masculino , Adulto , Abscesso do Psoas/etiologia , Infecções por HIV/complicações , Tuberculose da Coluna Vertebral/complicações , Tuberculose da Coluna Vertebral , Infecções Oportunistas Relacionadas com a AIDS , Terapia Antirretroviral de Alta Atividade , Ensaio de Imunoadsorção Enzimática , Hospedeiro Imunocomprometido , Infecções por HIV/tratamento farmacológico , Tomografia Computadorizada por Raios X , Tuberculose da Coluna Vertebral/tratamento farmacológicoRESUMO
BACKGROUND: Iliopsoas abscess remains a rare condition. Together with a decreasing incidence of tuberculosis infection, pyogenic iliopsoas abscess (PIPA) has become relatively more frequent and represents more than half of iliopsoas abscesses. OBJECTIVE: To analyze presentation, treatment, and outcomes in a series of patients with diagnosis of PIPA. DESIGN: Retrospective. SETTINGS: A single tertiary care institution. PATIENTS: A series of 34 consecutive patients with diagnosis of PIPA treated between 2001 and 2010 at the Hospital Italiano de Buenos Aires. MAIN OUTCOME MEASURES: Analyzed variables were: age, sex, diagnostic modality, clinical presentation, and treatment outcomes. RESULTS: Primary and secondary abscess occurred in 20.6% and 79.4%, respectively. The leading cause of PIPA was spondylodiscitis (38%) and computed tomography was the preferred diagnostic modality (87%). Most common presentation was left unilateral abscess in 66% of patients and most frequent isolated bacteria were Staphylococcus aureus. Fifteen patients (44%) received antibiotics as initial treatment with an initial failure rate of 80%; 11 of 15 patients required a second treatment. Sixteen patients (47%) underwent percutaneous drainage (PD) as first line treatment with a success rate of 50%. However, success rate of PD, increased to 100% after 2 drainages. Three patients were surgically drained without success (0 of 3 patients). Compared with the rest of the population, PD showed a lower hospital stay (25 vs. 14 d, respectively, P = 0.08) whereas surgery had a higher mortality rate (8% vs. 22%, respectively, P = 0.03). LIMITATIONS: A single institutional retrospective study. CONCLUSIONS: Our series showed a higher proportion of unilateral and secondary abscess. Spondylodiscitis was the first cause of PIPA. PD seems to be the best treatment option for PIPA and compared with surgery it is associated with a higher success rate and lower hospital stay and mortality rate.
Assuntos
Abscesso do Psoas/terapia , Dor Abdominal/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Dor nas Costas/etiologia , Drenagem/métodos , Feminino , Febre/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Abscesso do Psoas/etiologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto JovemRESUMO
This case report shows the clinical development of a patient with systemic paracoccidioidomycosis presenting with lymphatic-intestinalmanifestation. The patient initially had a substantial clinical improvement but had a recrudescence after six months of sulfamethoxazoletrimethoprim oral treatment, with the emergence of feverish syndrome, lumbar pain, and intermittent claudication, characterizing a bilateral iliopsoas muscle abscess, necessitating clinicosurgical therapeutics.
Assuntos
Enteropatias/complicações , Doenças Linfáticas/etiologia , Paracoccidioidomicose/complicações , Abscesso do Psoas/etiologia , Humanos , Masculino , Paracoccidioides , Adulto JovemRESUMO
This case report shows the clinical development of a patient with systemic paracoccidioidomycosis presenting with lymphatic-intestinalmanifestation. The patient initially had a substantial clinical improvement but had a recrudescence after six months of sulfamethoxazoletrimethoprim oral treatment, with the emergence of feverish syndrome, lumbar pain, and intermittent claudication, characterizing a bilateral iliopsoas muscle abscess, necessitating clinicosurgical therapeutics.
Este relato de caso descreve a evolução clínica de paciente comparacoccidioi-domicose sistêmica com manifestação linfática-intestinal.O paciente evoluiu inicialmente com melhora clínica acentuada erecrudescência após seis meses de uso de SMX-TMP pela via oral, com o surgimento de síndrome febril, dor lombar, e claudicação intermitente,caracterizando um abscesso bilateral do músculo íleopsoas, comnecessidade de terapêutica clínico-cirúrgica.
Assuntos
Humanos , Masculino , Adulto Jovem , Enteropatias/complicações , Doenças Linfáticas/etiologia , Paracoccidioidomicose/complicações , Abscesso do Psoas/etiologia , ParacoccidioidesAssuntos
Dor Abdominal/etiologia , Apendicite/diagnóstico , Fístula Cutânea/diagnóstico , Abscesso do Psoas/diagnóstico , Doença Aguda , Apendicite/complicações , Fístula Cutânea/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Abscesso do Psoas/etiologia , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: In order to describe the case of an adolescent who developed psoas abscesses caused by Paracoccidiodes brasiliensis. DESCRIPTION: A 12-year-old boy was admitted with a history of daily fever and global lymph nodes enlargement. He had been treated in the last 6 years, with irregular use of the drugs, for an acute form of paracoccidioidomycosis (PCM). He presented a tenderness fluctuating polyadenopathy in all cervical, submandibular, supraclavicular, axillary, and inguinal chains; several lymph nodes were up to 4 cm in diameter, hardened and coalescent. After 1 month of unsuccessful therapy with SMX-TMP, the patient presented a pain in the right groin and difficulty to walk. CT scan showed a global retroperitoneal lymph nodes enlargement, some with central necrosis and two bigger collections adjacent to both psoas muscles. A surgical drainage of the collections was performed for several times. The patient received a total of 1.9 g of Amphotericin B. After 1 month of the last surgical procedure, CT scan showed only a residual collection, and the patient was sent to ambulatory follow-up. We hypothesed that the retroperitoneal lymph nodes became a coalescent mass that fistulized to the psoas compartment. COMMENTS: The patient presented a febrile lymphoproliferative syndrome that is frequently seen in children with PCM. Although a polymorphic manifestation is observed in this disease, psoas abscess is a rare complication of PCM. The health professionals that take care of the patients with PCM must pay attention to the possibility of this one more complication.
Assuntos
Paracoccidioidomicose/complicações , Abscesso do Psoas/etiologia , Adolescente , Anfotericina B/uso terapêutico , Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Criança , Terapia Diretamente Observada , Febre , Humanos , Infusões Intravenosas , Itraconazol/administração & dosagem , Itraconazol/uso terapêutico , Linfonodos/diagnóstico por imagem , Masculino , Paracoccidioides/isolamento & purificação , Paracoccidioidomicose/tratamento farmacológico , Paracoccidioidomicose/fisiopatologia , Cooperação do Paciente , Abscesso do Psoas/diagnóstico por imagem , Abscesso do Psoas/tratamento farmacológico , Abscesso do Psoas/cirurgia , Radiografia , Combinação Trimetoprima e Sulfametoxazol/administração & dosagem , Combinação Trimetoprima e Sulfametoxazol/uso terapêuticoAssuntos
Micetoma/diagnóstico , Scedosporium/isolamento & purificação , Adulto , Antibacterianos/uso terapêutico , Antifúngicos/uso terapêutico , Artrite Infecciosa/complicações , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/microbiologia , Artrite Infecciosa/cirurgia , Bacteriemia/complicações , Ciprofloxacina/uso terapêutico , Terapia Combinada , Desbridamento , Drenagem , Quimioterapia Combinada , Glomerulonefrite/complicações , Humanos , Hospedeiro Imunocomprometido , Itraconazol/uso terapêutico , Linfangite/etiologia , Masculino , Micetoma/complicações , Micetoma/tratamento farmacológico , Micetoma/cirurgia , Abscesso do Psoas/etiologia , Abscesso do Psoas/microbiologia , Abscesso do Psoas/cirurgia , Infecções Estafilocócicas/complicações , Vancomicina/uso terapêuticoRESUMO
Psoas abscess is an uncommon disease with varied etiology. The most common pathogen in primary abscess is Staphylococcus aureus. Crohn's disease is the most common cause of a secondary abscess. Recently, drug abuse and HIV infection have become important risk factors in identification of a patient with psoas abscess. Mycobacterium tuberculosis is considered an extremely rare cause of psoas abscess, but it is reported in HIV patients. Physical presentation is insidious; classical symptoms are pain and fever. Computed tomography (CT) is the most important tool for diagnosis. Preferred treatment is percutaneous drainage guided by CT. Open surgical drainage should be reserved if percutaneous drainage fails, if possible by extraperitoneal approach; in secondary abscess, the transperitoneal approach is preferred to correct the possible disease.
Assuntos
Infecções por HIV/complicações , Abscesso do Psoas/etiologia , Tuberculose/etiologia , Adulto , Humanos , MasculinoRESUMO
A 65-year-old man with a left uncemented total hip arthroplasty performed 11 years previously was admitted with a history of progressive low back pain, left hip pain, and sepsis that had begun 6 months earlier. On physical examination, a gross, fluctuant mass was palpated in the left thigh. A computed tomography (CT) scan revealed a 6.5 x 3 cm left retrofascial psoas abscess communicating with the hip joint. The patient underwent irrigation and débridement of the hip with removal of the components. The psoas abscess was drained through the iliopsoas bursa. A residual psoas abscess was drained percutaneously under CT guidance. Cultures isolated Escherichia coli, and the patient responded to 6 months of ciprofloxacin therapy. After 1 year, the patient had no evidence of infection. Pathways of infection spread, diagnosis, and treatment of a patient with this rare association are discussed with a review of the literature.
Assuntos
Artroplastia de Quadril/efeitos adversos , Infecções Relacionadas à Prótese/complicações , Abscesso do Psoas/etiologia , Idoso , Anti-Infecciosos/uso terapêutico , Ciprofloxacina/uso terapêutico , Desbridamento , Drenagem , Infecções por Escherichia coli/terapia , Humanos , Masculino , Abscesso do Psoas/microbiologia , Abscesso do Psoas/terapia , Tomografia Computadorizada por Raios XRESUMO
La tuberculosis es un problema de salud pública, prevalente en México, las manifestaciones extrapulmonares son frecuentes. El psoas se afecta cuando hay ruptura de abscesos de columna toracolumbar (mal de Pott); la afección primaria es rara. Presentamos el caso clínico de un paciente joven, en quien se encontró por cirugía un absceso solitario, granulomatoso primario del psoas derecho, sin lesiones en otro sitio. La etiología tuberculosa fue la más probable, dado los datos clínicos, epidemiológicos, histopatológicos y de imágenes (ultrasonido, tomografía computada, resonancia magnética y gammagrafía). Se inició tratamiento con rifampicina, pirazinamida, etambutol e isoniacida, con buena respuesta durante el seguimiento
Assuntos
Humanos , Masculino , Adolescente , Tuberculose da Coluna Vertebral/diagnóstico , Abscesso do Psoas/diagnóstico , Abscesso do Psoas/etiologiaRESUMO
Primary psoas abscess is an uncommon disease. In children, clinical manifestations is often inspecific leading to diagnostic delay. The authors relate a primary pyogenic abscess of the psoas muscle in a 7-year-old girl with secondary septic arthritis of the hip. Confirmation of diagnosis was established by computerized tomography (CT) of the abdominal and pelvic areas. A review of the literature is presented about clinical manifestations, pathogenesis, differential diagnosis, etiology, diagnostic and therapeutic management of this infrequent entity.
Assuntos
Abscesso do Psoas/diagnóstico , Infecções Estreptocócicas/diagnóstico , Streptococcus pyogenes , Artrite Infecciosa/complicações , Criança , Diagnóstico Diferencial , Feminino , Humanos , Abscesso do Psoas/etiologia , Infecções Estreptocócicas/etiologia , Tomografia Computadorizada por Raios XRESUMO
The experience with 14 patients affected of abscess of the psoas iliac muscle, attended at a general hospital through 1983-1995 is analized. This is a disease difficult to diagnose; it is usually diagnosed after a long delay (average of 45 days); it affects mainly women (rate F/M 11: 3), with a mean age in our patients of 50.4 years (14-79). The most frequent sign was fever (86% of the patients). Pain involving the thigh was present in 57%, and the psoas' sign in 36%. Even when this sign was present it did not always orient to the correct diagnosis. In two cases, the abscess was considered primary and in twelve it was associated to osteomyelitis, urinary tract infection or tumor (cancer of colon, metastasis in small bowell, melanoma and cancer of cervix). Gram smears and cultures of the material obtained by puncture were useful for detecting the causal germ, but blood cultures were inferior in yielding it (1 positive in 8 cases). Gram positive germs were predominant (Staphylococci coag. + in 4, Staph. coag.--in one, beta hemolytic Streptococci, 1). Gram negative germs were associated with urinary tract infections and staghorn lithiasis. In one case the etiology was TBC. Abdominal TAC was diagnostic when correlated with clinical data in 100% of the cases; ecography was diagnostic in only 2 of 11 cases. Patients were treated with antibiotics and percutaneous drainage; the only deaths occurred in patients with cancer.