Psoas abscess due to Pasteurella multocida

Psoas abscess is a pus collection within the muscle compartment. It is a very uncommon entity. It can be primary as a result of haematogenous spread or secondary as a consequence of a direct extension of an infectious focus. Diagnosis is usually delayed because nonspecific clinical presentation. Staphylococcus aureus is the most common organism cultured in this type of abscess. We describe a secondary psoas abscess in an elderly female patient. The patient presented with fever, right groin pain and malaise. Following laboratory, radiological and microbiological analyses the patient was diagnosed as having a psoas abscess due to Pasteurella multocida, which is a Gram negative bacteria, part of the normal oral flora of many animals and can causes human infections after animal scratches or bites. More rarely is to find this organism causing psoas abscesses. Because of insidious clinical presentation, the diagnosis of psoas abscess is a challenge and a high index of suspicion is required. We emphasize the importance of bacteriological confirmation of microorganism involved to choose the correct antibiotics. Percutaneous drainage is the treatment of choice. Open surgical drainage should be reserved if percutaneous drainage fails.     

Segmental portal hypertension due to a retroperitoneal abscess of tuberculous etiology

We report a patient with segmental portal hypertension secondary to a retroperitoneal tuberculous abscess. The patient was admitted to the hospital because of upper gastrointestinal bleeding. Gastric varices were the only lesion found at endoscopy. At laparotomy a retroperitoneal abscess was found as the etiology of splenic vein thrombosis. We emphasize the low frequency of this finding and its resolution after splenectomy and antituberculous drugs.     

Psoas abscess: Difficulties encountered

From 1961 to 1989, 67 patients underwent various surgical procedures for psoas abscess. Retrospective analysis was undertaken in an effort to determine optimal surgical therapy. Forty patients were cured with one operation. Twenty-one patients required two operations, four patients required three operations, and two patients required more than three operations. The reason for failure of treatment was failure to resect the diseased bowel or to drain the psoas abscess adequately. A technique to recognize and treat the abscess definitively will be illustrated. The most common etiologies were Crohn's disease in 49 patients, postoperative sepsis in eight patients, and complications of renal disease in four patients. The length of hospital stay ranged from 5 to 392 days (mean, 26 days). There were two deaths. Failure to recognize and treat psoas abscess results in considerable morbidity.Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, St. Louis, Missouri, April 29 to May 4, 1990.     

Psoas abscess complicating Crohn's disease]

Psoas abscess were found in 6 cases among 166 patients with Crohn's disease between 1985 and 1989; in one case, it was the first sign of Crohn's disease. Diagnosis was usually difficult and should be suspected on the following signs: lower abdominal quadrant pain, psoitis, abdominal mass, sciatica or pain along the course of the femoral nerve. Diagnosis was confirmed in nearly all cases by computerized axial tomography. Effective therapy combines drainage and bowel resection.     

Psoas abscess from ureteric stone perforation

This case illustrates a rare complication of an impacted ureteric stone which eroded through the wall of the ureter leading to formation of a psoas abscess. Ureteric stent placement and percutaneous drainage of the abscess were insufficient to resolve the problem. Renal scan revealed poor function and the left kidney was removed. It showed evidence of acute supporative pyelonephritis with nephrolithiasis.     

腹内淋巴结结核的影像学诊断

OBJECTIVE: To evaluate the value of X-ray imaging for diagnosing abdominal tuberculous lymphadenopathy. METHODS: 27 cases of tuberculous lymphadenopathy proved by clinical or pathohistological evidence were collected, all of which were examined with radiological imaging methods. RESULTS: The typical CT findings enlarged lymph nodes with peripheral or multilocular enhancement. Enlarged lymph nodes with multiple flecked or massive calcifications were important for diagnosis. Ultrasound examination showed enlarged lymph nodes with uniform echo (less than 2 cm) and with heterogeneous echo (larger than 2 cm). The aim of the barium meal examination of the gastrointestinal tract was to find tuberculous lymphadenopathy encroaching on intestine or merged with intestinal tuberculosis. Abdominal X-ray plain film was helpful to find the calcified tuberculous lymphadenopathy and intestinal obstruction. CONCLUSIONS: Various imaging methods have shown their diagnostic value, but CT was the most important tool for definite diagnosis of tuberculous lymphadenopathy. Ultrasound was more useful for follow-up cases.     

Mediastinal lymphadenopathy due to mycobacterial infection

Tuberculous lymphadenitis without pulmonary manifestation is an uncommon entity in developed countries, and the possibility of tuberculous infection is usually ignored in the differential diagnosis of lymphadenopathy. Therefore, appropriate treatment may be delayed. Paralysis of the recurrent laryngeal nerve caused by mediastinal lymphadenopathy due to tuberculosis is an extremely rare condition. In this paper, we present a patient who had vocal cord paralysis caused by tuberculous lymphadenopathy of the superior mediastinum. After anti-tuberculosis treatment, vocal cord function was only partially recovered, while the clinical, radiological, and laboratory abnormalities were completely recovered.     

Unusual complication of cervical tuberculous lymphadenopathy

Lymphadenopathy is the most common form of extrapulmonary tuberculosis; cervical region being the most frequent site. Yet, tuberculous cervical lymphadenopathy is rarely associated with Internal Jugular Vein (IJV) thrombosis. We report right IJV thrombosis with isolated cervical tuberculous lymphadenopathy in a 22-year-old woman. Anti-tuberculous treatment resulted in complete regression of lymphadenopathy but anticoagulation treatment failed to restore the caliber of thrombosed IJV to normal. Thrombosis of adjacent IJV is a potential complication of delay in diagnosis and treatment of cervical lymphnode tuberculosis.     

Psoas abscess diagnosed at a Northern university hospital

Abscess of the psoas muscle is an infrequent diagnosis at hospitals in Northern countries. We report on 16 patients who had this diagnosis during the period 1991-2001. Eight patients were immigrants who had previously been healthy and most of them had experienced symptoms for approximately 1 y. MRI or CT scans revealed spondylodiscitis in 6 of these patients and Mycobacterium tuberculosis was identified as the causative agent. With the exception of 1 patient who was exclusively treated with antituberculous agents, all 8 immigrant patients were successfully treated with antituberculous agents in addition to percutaneous drainage. The other 8 patients were Norwegians, 4 of whom had underlying conditions such as diabetes mellitus or drug abuse. The causative microorganisms were Staphylococcus aureus or Streptococcus spp., with the exception of M. tuberculosis in 1 case. The Norwegian patients had a more acute history of symptoms than the immigrant patients and 2 of them were in a septic condition on admittance. Two of the Norwegians died of serious infection; 5 were successfully treated with percutaneous drainage in addition to antibiotics and 1 was treated exclusively with antibiotic agents. The clinical history and microorganism associated with psoas abscess seemed to depend on whether or not the patient was an immigrant. Owing to increasing immigration, diagnosis of psoas abscess should be taken into account in Northern countries.