- Denis Spelman, MBBS, FRACP, FRCPA, MPH
Denis Spelman, MBBS, FRACP, FRCPA, MPH
- Adjunct Professor, Monash University
- Alfred Hospital, Victoria, Australia
Psoas (or iliopsoas) abscess is a collection of pus in the iliopsoas muscle compartment . It may arise via contiguous spread from adjacent structures or by the hematogenous route from a distant site. The incidence is rare, but the frequency of this diagnosis has increased with the use of computed tomography, prior to which most cases were diagnosed at postmortem . The anatomy, pathogenesis, microbiology, clinical manifestations, diagnosis, and treatment of psoas abscess will be reviewed here.
Understanding the clinical manifestations, complications, and management of psoas abscess requires knowledge of the anatomy of the psoas muscle and its adjacent structures.
The psoas muscle arises from the transverse processes and the lateral aspects of the vertebral bodies between the 12th thoracic and the 5th lumbar vertebrae. From this origin, it courses downward across the pelvic brim, passes deep to the inguinal ligament and anterior to the hip joint capsule to form a tendon that inserts into the lesser trochanter of the femur. The iliacus muscle joins the psoas to insert via the same tendon. The iliacus and psoas muscles are the main hip flexors.
The psoas and iliacus are sometimes considered together as the iliopsoas muscle, located in an extraperitoneal space called the iliopsoas compartment. The tendon is separated from the hip capsule by the iliopsoas bursa. This bursa is in communication with the hip joint space in up to 15 percent of persons, which may facilitate spread of infection between these sites.
The psoas muscle is situated near a number of important anatomical structures including the vertebral bodies, the abdominal aorta, the sigmoid colon, the appendix, the hip joint, and iliac lymph nodes. Infection may spread directly between these structures and the psoas muscle.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Mallick IH, Thoufeeq MH, Rajendran TP. Iliopsoas abscesses. Postgrad Med J 2004; 80:459.
- Mückley T, Schütz T, Kirschner M, et al. Psoas abscess: the spine as a primary source of infection. Spine (Phila Pa 1976) 2003; 28:E106.
- Ricci MA, Rose FB, Meyer KK. Pyogenic psoas abscess: worldwide variations in etiology. World J Surg 1986; 10:834.
- Santaella RO, Fishman EK, Lipsett PA. Primary vs secondary iliopsoas abscess. Presentation, microbiology, and treatment. Arch Surg 1995; 130:1309.
- Navarro López V, Ramos JM, Meseguer V, et al. Microbiology and outcome of iliopsoas abscess in 124 patients. Medicine (Baltimore) 2009; 88:120.
- Gruenwald I, Abrahamson J, Cohen O. Psoas abscess: case report and review of the literature. J Urol 1992; 147:1624.
- Buttaro M, González Della Valle A, Piccaluga F. Psoas abscess associated with infected total hip arthroplasty. J Arthroplasty 2002; 17:230.
- Lee BB, Ngan Kee WD, Griffith JF. Vertebral osteomyelitis and psoas abscess occurring after obstetric epidural anesthesia. Reg Anesth Pain Med 2002; 27:220.
- Dolfin D, Barkin J, Arenson AM, Herschorn S. Psoas abscess after operation on lumbar spine. Urology 1983; 21:544.
- Lin SS, Vaccaro AR, Reisch S, et al. Low-velocity gunshot wounds to the spine with an associated transperitoneal injury. J Spinal Disord 1995; 8:136.
- Lin MF, Lau YJ, Hu BS, et al. Pyogenic psoas abscess: analysis of 27 cases. J Microbiol Immunol Infect 1999; 32:261.
- Alpantaki K, Papoutsidakis A, Katonis P, Hadjipavlou A. Vertebral osteomyelitis, epidural and psoas abscess after epidural catheter use. Acta Orthop Belg 2007; 73:670.
- Maron R, Levine D, Dobbs TE, Geisler WM. Two cases of pott disease associated with bilateral psoas abscesses: case report. Spine (Phila Pa 1976) 2006; 31:E561.
- Dauchy FA, Dupon M, Dutronc H, et al. Association between psoas abscess and prosthetic hip infection: a case-control study. Acta Orthop 2009; 80:198.
- Gordin F, Stamler C, Mills J. Pyogenic psoas abscesses: noninvasive diagnostic techniques and review of the literature. Rev Infect Dis 1983; 5:1003.
- Ogihara M, Masaki T, Watanabe T, et al. Psoas abscess complicating Crohn's disease: report of a case. Surg Today 2000; 30:759.
- Yacoub WN, Sohn HJ, Chan S, et al. Psoas abscess rarely requires surgical intervention. Am J Surg 2008; 196:223.
- Hsu RB, Lin FY. Psoas abscess in patients with an infected aortic aneurysm. J Vasc Surg 2007; 46:230.
- Inufusa A, Mikawa Y, Morita I, Fujiwara T. Ruptured abdominal aortic aneurysm associated with a psoas abscess. Arch Orthop Trauma Surg 2002; 122:306.
- Sharif MA, Lee B, Lau LL, et al. Prosthetic stent graft infection after endovascular abdominal aortic aneurysm repair. J Vasc Surg 2007; 46:442.
- Klonaris C, Vourliotakis G, Katsargyris A, et al. Primary aortoduodenal fistula without abdominal aortic aneurysm in association with psoas abscess. Ann Vasc Surg 2006; 20:541.
- Lee YT, Lee CM, Su SC, et al. Psoas abscess: a 10 year review. J Microbiol Immunol Infect 1999; 32:40.
- Alan C, Ataus S, Tunç B. Xanthogranulamatous pyelonephritis with psoas abscess: 2 cases and review of the literature. Int Urol Nephrol 2004; 36:489.
- Flavin NE, Gomez M. Fever, pain, and a limp: a case of a psoas and spinal epidural abscess caused by methicillin-resistant Staphylococcus aureus in a diabetic patient. J Natl Med Assoc 2009; 101:84.
- De U, Pal DK. Seventy cases of non-tubercular psoas abscess at a rural referral centre in South Bengal. Trop Doct 2006; 36:53.
- Ulu-Kilic A, Karakas A, Erdem H, et al. Update on treatment options for spinal brucellosis. Clin Microbiol Infect 2014; 20:O75.
- Chang CM, Ko WC, Lee HC, et al. Klebsiella pneumoniae psoas abscess: predominance in diabetic patients and grave prognosis in gas-forming cases. J Microbiol Immunol Infect 2001; 34:201.
- Giladi M, Sada MJ, Spotkov J, Bayer AS. Pneumococcal psoas abscess: report of a case and review of the world literature. Isr J Med Sci 1996; 32:771.
- Dubois D, Robin F, Bouvier D, et al. Streptobacillus moniliformis as the causative agent in spondylodiscitis and psoas abscess after rooster scratches. J Clin Microbiol 2008; 46:2820.
- Tamargo Delpón M, Demelo-Rodríguez P, Cano Ballesteros JC, Vela de la Cruz L. [Psoas abscess caused by Staphylococcus lugdunensis]. Rev Argent Microbiol 2016; 48:119.
- Palavutitotai N, Chongtrakoo P, Ngamskulrungroj P, Chayakulkeeree M. NOCARDIA BEIJINGENSIS PSOAS ABSCESS AND SUBCUTANEOUS PHAEOHYPHOMYCOSIS CAUSED BY PHAEOACREMONIUM PARASITICUM IN A RENAL TRANSPLANT RECIPIENT: THE FIRST CASE REPORT IN THAILAND. Southeast Asian J Trop Med Public Health 2015; 46:1049.
- Heyd J, Meallem R, Schlesinger Y, et al. Clinical characteristics of patients with psoas abscess due to non-typhi Salmonella. Eur J Clin Microbiol Infect Dis 2003; 22:770.
- Aoyama M, Nemoto D, Matsumura T, Hitomi S. A fatal case of iliopsoas abscess caused by Salmonella enterica serovar Choleraesuis that heterogeneously formed mucoid colonies. J Infect Chemother 2015; 21:395.
- Bozbaş GT, Ünübol Aİ, Gürer G. Seronegative brucellosis of the spine: A case of psoas abscess secondary to brucellar spondylitis. Eur J Rheumatol 2016; 3:185.
- Galy A, Decousser JW, El-Anbassi S, et al. Psoas abscess and chronic Q fever: a contiguous or hematogenous complication? A case report and literature review. Infect Dis (Lond) 2016; 48:626.
- Leeman M, Burgers P, Brehm V, van Brussel JP. Psoas abscess after bacille Calmette-Guérin instillations causing iliac artery contained rupture. J Vasc Surg 2017; 66:1236.
- Han YM, Kim AY, Lim RK, et al. Neonatal Iliopsoas Abscess: The First Korean Case. J Korean Med Sci 2015; 30:1203.
- Huang JJ, Ruaan MK, Lan RR, Wang MC. Acute pyogenic iliopsoas abscess in Taiwan: clinical features, diagnosis, treatments and outcome. J Infect 2000; 40:248.
- Bresee JS, Edwards MS. Psoas abscess in children. Pediatr Infect Dis J 1990; 9:201.
- Stefanich RJ, Moskowitz A. Hip flexion deformity secondary to acute pyogenic psoas abscess. Orthop Rev 1987; 16:67.
- Fish DE, Middleton K, Gluzman A. Atypical presentation of osteomyelitis, discitis, epidural, and iliopsoas abscess in diffuse idiopathic skeletal hyperostosis (DISH) syndrome. Am J Phys Med Rehabil 2008; 87:960.
- Arai Y, Kawakami T, Soga H, Okada Y. Psoas abscess associated with iliac vein thrombosis and piriformis and gluteal abscesses. Int J Urol 1999; 6:257.
- Ijaz M, Sakam S, Ashraf U, Marquez JG. Unusual Presentation of Recurrent Pyogenic Bilateral Psoas Abscess Causing Bilateral Pulmonary Embolism by Iliac Vein Compression. Am J Case Rep 2015; 16:606.
- Volpin A, Kini SG, Berizzi A. Psoas muscle pyogenic abscess in association with infected hip arthroplasty: a rare case of simultaneous bilateral presentation. BMJ Case Rep 2015; 2015.
- Zissin R, Gayer G, Kots E, et al. Iliopsoas abscess: a report of 24 patients diagnosed by CT. Abdom Imaging 2001; 26:533.
- Takada T, Terada K, Kajiwara H, Ohira Y. Limitations of using imaging diagnosis for psoas abscess in its early stage. Intern Med 2015; 54:2589.
- Lee JK, Glazer HS. Psoas muscle disorders: MR imaging. Radiology 1986; 160:683.
- Kao PF, Tzen KY, Tsui KH, et al. The specific gallium-67 scan uptake pattern in psoas abscesses. Eur J Nucl Med 1998; 25:1442.
- Kimizuka Y, Ishii M, Murakami K, et al. A case of skeletal tuberculosis and psoas abscess: disease activity evaluated using (18) F-fluorodeoxyglucose positron emission tomography-computed tomography. BMC Med Imaging 2013; 13:37.
- Kishi Y, Kajiwara S, Seta S, et al. Retroperitoneal schwannoma misdiagnosed as a psoas abscess: report of a case. Surg Today 2002; 32:849.
- Dave BR, Kurupati RB, Shah D, et al. Outcome of percutaneous continuous drainage of psoas abscess: A clinically guided technique. Indian J Orthop 2014; 48:67.
- Atkin G, Qurashi K, Isla A. Laparoscopic drainage of bilateral tuberculous psoas abscesses. Surg Laparosc Endosc Percutan Tech 2005; 15:380.
- Hsieh MS, Huang SC, Loh el-W, et al. Features and treatment modality of iliopsoas abscess and its outcome: a 6-year hospital-based study. BMC Infect Dis 2013; 13:578.
- Sherman SJ, Stern J, Neufeld P. Recurrent psoas abscess. Postgrad Med 1987; 81:96, 99.