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
A 40-year-old woman was scheduled to receive chemotherapy for a high-risk common B-cell acute lymphoblastic leukemia (ALL), diagnosed 10 months earlier in the wake of lower limb bruising and petechiae, and metrorrhagia. At that time, she had thrombocytopenia and a normal transvaginal gynecological ultrasound. Upon admission, she complained of a 3-month history of incapacitating left groin pain radiated to the thigh, and right lower quadrant abdominal pain associated with diarrhea. On physical examination, she had tenderness in the right iliac fossa and a positive psoas sign on the left. Computerized scan of the abdomen and pelvis reported an image compatible with a left psoas abscess and signs of typhlitis. The biopsy of the left psoas muscle demonstrated infiltration by nests and cords of moderately differentiated keratinizing squamous carcinoma. Gynecological examination revealed macroscopic abnormalities of the cervix correlated with the same histopathological diagnosis. The second primary cancers most frequently associated with ALL are Hodgkin lymphoma, squamous skin cancer, endocrine tumors, kidney cancer, non-Hodgkin lymphoma, and breast cancer. Muscle metastases from solid tumors are rare, and usually arise from the lung, kidney, thyroid, and melanoma. Malignant psoas syndrome is caused by neoplastic infiltration of the muscle. The differential diagnosis should be made with a psoas abscess, which may arise from typhlitis if secondary. We have not been able to find records of cervical cancer as second primary cancer after ALL.
Una mujer de 40 años se internó de forma programada para recibir quimioterapia por una leucemia linfoblástica aguda (LLA) B común de alto riesgo, diagnosticada 10 meses antes a raíz de hematomas y petequias en los miembros inferiores, y metrorragia. En ese momento, presentaba trombocitopenia y una ecografía ginecológica transvaginal normal. Al ingreso de la internación programada, se quejó de dolor inguinal izquierdo con irradiación al muslo e impotencia funcional de 3 meses de evolución, dolor en fosa ilíaca derecha y diarrea. En el examen físico tenía dolor a la palpación profunda en la fosa ilíaca derecha y signo del psoas positivo a la izquierda. La tomografía de abdomen y pelvis reveló una imagen compatible con un absceso del psoas izquierdo y signos de tiflitis. La biopsia del psoas izquierdo demostró infiltración por nidos y cordones de carcinoma escamoso queratinizante moderadamente diferenciado. El examen ginecológico dirigido evidenció anomalías macroscópicas del cuello uterino correlacionadas con el mismo diagnóstico histopatológico. Los segundos cánceres primarios más frecuentemente asociados a LLA son linfoma de Hodgkin, cáncer escamoso de piel, tumores endocrinos, cáncer renal, linfoma no-Hodgkin y cáncer de mama. Las metástasis musculares de tumores sólidos son infrecuentes, y habitualmente provienen del pulmón, riñón, tiroides y melanoma. El síndrome del psoas maligno es causado por infiltración neoplásica del músculo. El diagnóstico diferencial debe realizarse con el absceso del psoas, que puede originarse en una tiflitis si es secundario. No hemos podido encontrar registros de cáncer de cuello uterino como segundo cáncer primario luego de LLA.
Assuntos
Carcinoma de Células Escamosas , Abscesso do Psoas , Neoplasias do Colo do Útero , Adulto , Biópsia , Diagnóstico Diferencial , Feminino , Humanos , Abscesso do Psoas/diagnósticoRESUMO
CASE: We present a case of a 70-year-old woman with simultaneous periprosthetic joint infection (PJI) of both hips and left knee due to a bilateral psoas abscess. The patient underwent debridement and implants removal with the consequent reimplantation in a sequential six-stage revision surgery. At four years of follow-up and in spite of the patient's comorbidities and current PJI presentation, she maintains full activities of daily living without restrictions. CONCLUSION: Accurate and early diagnosis of a psoas abscess is crucial. This case report provides experience of a complex scenario, the decision-making involved and the outcomes of an underdiagnosed complication.
Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Diagnóstico Tardio , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/cirurgia , Abscesso do Psoas/complicações , Abscesso do Psoas/diagnóstico , Reoperação/métodos , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/diagnóstico , Staphylococcus aureus , Idoso , Feminino , HumanosRESUMO
BACKGROUND Iliacus muscle abscess is a rare condition that frequently presents with nonspecific clinical symptoms. Abscesses in the iliacus muscle can arise from contiguous spread from adjacent structures or from distant sites via hematogenous or lymphatic routes. CASE REPORT We report a case of iliacus muscle abscess in a 22-year-old female microbiologist who presented to the emergency department with severe back pain and lower-extremity weakness after returning from a trip to Mexico. She was found to have urinary tract infection due to Salmonella. The patient was found to have left iliacus muscle abscess and septic arthritis of the sacroiliac joint. She was initially treated with piperacillin-tazobactam, vancomycin, and metronidazole, which were later switched to intravenous ceftriaxone and oral levofloxacin. She was successfully treated with antibiotics, with a complete resolution of the multiple tiny abscesses. CONCLUSIONS Iliacus muscle abscess presents with nonspecific symptoms that can mimic neurologic diseases such as spinal cord compression. A high index of suspicion is required to make an early diagnosis and initiate prompt treatment with antibiotics and abscess drainage, if accessible. A detailed history is essential to assess risk factors and establish likely causative organisms. Delay in treatment can lead to an increase in morbidity and mortality. Long-term follow-up is crucial, as the incidence of relapse is high.
Assuntos
Artrite Infecciosa/diagnóstico , Abscesso do Psoas/diagnóstico , Abscesso/tratamento farmacológico , Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/microbiologia , Quimioterapia Combinada , Diagnóstico Precoce , Feminino , Humanos , México , Abscesso do Psoas/tratamento farmacológico , Abscesso do Psoas/microbiologia , Infecções por Salmonella/tratamento farmacológico , Viagem , Infecções Urinárias/diagnóstico , Infecções Urinárias/microbiologia , Adulto JovemRESUMO
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
Extragonadal non-gestational choriocarcinoma (ENC) is an uncommon malignant tumor occasionally found in the gastrointestinal tract. ENC is characterized by a biphasic tumor growth with distinct areas of adenocarcinoma and choriocarcinoma differentiation. Primary choriocarcinoma of the colon is extremely rare, with only 21 cases reported in the literature. Most of the perforation of colorectal cancers occurs in the abdominal cavity, while abdominal wall abscess is rare; the psoas abscess associated with colon carcinoma is even less observed. Herein, we report the case of a 61-year-old female with poorly differentiated adenocarcinoma of the ascending colon and sigmoid, with choriocarcinomatous differentiation, masquerading a psoas abscess formation. Unfortunately, despite the aggressive therapy, the patient's disease rapidly progressed, and she died within 2 months after the diagnosis. The typical morphological pattern, immunohistochemistry, and its correlation with serum β-human chorionic gonadotropin enabled a correct diagnosis.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Neoplasias Colorretais , Adenocarcinoma/diagnóstico , Abscesso do Psoas/diagnóstico , Colo , Coriocarcinoma não Gestacional , Coriocarcinoma , Parede Abdominal , Abscesso/diagnósticoRESUMO
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
Resumen: Si bien es infrecuente, el absceso del músculo iliopsoas exhibe una alta tasa de morbilidad y mortalidad. Su diagnóstico es difícil debido a las numerosas etiologías y su variada presentación clínica. Objetivo: Discutir las causas, vías de diseminación, diagnósticos diferenciales y manejo del absceso del iliopsoas, poniendo especial énfasis en el rol de la tomografía computada y la resonancia magnética en su diagnóstico. Conclusión: La evaluación con estudios de imagen es esencial para determinar la complejidad, extensión y origen anatómico de esta patología, parámetros que son fundamentales para determinar el pronóstico y el manejo en este tipo de pacientes.
Abstract: Although rare, iliopsoas abscess has a high rate of morbidly and mortality. Its diagnosis is diffiult given the numerous etiologies and varied clinical presentation. Objective: To discuss the causes, dissemination pathways, differential diagnoses and management of iliopsoas abscess; emphasizing the important role of CT and MR through multiple imaging examples. Conclusion: Imagenological analysis is essential to determine complexity, extention, and anatomical origin of this condition, fundamental parameters in the prognosis and management of these patients.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Abscesso do Psoas/diagnóstico , Abscesso do Psoas/diagnóstico por imagem , Espectroscopia de Ressonância Magnética/métodos , Tomografia Computadorizada por Raios XRESUMO
El absceso del psoas es una entidad clínica rara, de difícil diagnóstico en edad pediátrica, con presentación ambigua, retrasando así el diagnóstico y tratamiento. Pueden ser primarios o secun- darios, siendo los primarios unilaterales en el 98%, alrededor del 70% de los casos se han reportado en el grupo de edad de 10-17 años, 75% en el sexo masculino. Únicamente en 20% de los casos se identifica el factor causal. Con incidencia anual de doce en países desarrollados. Se presenta caso de masculino de 15 años, procedente de Juticalpa Olancho, con anteceden- te de apendicectomía hace 10 años, inicia con dolor abdominal de 22 días de evolución, localiza- do en hipocondrio derecho, de intensidad progresiva. Posteriormente, claudicación y fiebre, fue llevado a clínica privada y manejado con analgésico sin mejoría. Evaluado nuevamente en clínica privada donde indican realizar ultrasonido abdominal que reporto masa heterogénea en correde- ra para-cólica derecha, considerar absceso del psoas y referencia a Hospital Materno Infantil, Tegucigalpa. Al ingreso febril, con dolor a la palpación profunda en hipocondrio derecho y dificultad de extender miembro inferior derecho por dolor. Los exámenes laboratoriales eran com- patibles con proceso infeccioso y el USG abdominal confirmó el diagnostico. Con evolución clínica satisfactoria y ultrasonido control reflejo reducción de la colección a 9ml por lo que se omitió la TAC...(AU)