Psoas Abscess and Hematoma

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Spontaneous dissection from a primary site in the retro-fascial space deep to the transversalis fascia into the ex-traperitoneal compartments is rare.3 The iliopsoas compartment is an extraperitoneal space covered by the iliopsoas fascia. The greater psoas muscle originates from the transverse processes of T12 and the lumbar vertebrae and extends inferiorly to merge with the iliac muscle at the L5-S2 level, becoming the iliopsoas muscle. The iliopsoas muscle passes beneath the inguinal ligament to insert on the lesser trochanter of the femur via the psoas

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tendon. Psoas abscesses generally do not originate within the psoas compartment but spread here from neighboring intraabdominal structures.275 Most psoas abscesses have a pyogenic origin and generally are due to direct spread from spinal or epidural infections, bowel conditions such as Crohn's disease, diverticulitis, appendicitis, perforated colon cardinoma, and perirenal abscesses. Primary abscesses rarely occur and are usually idiopathic. The organisms are typically Staphylococcus aureus and mixed gram-negative organisms. Tuberculous psoas abscesses are increasing in incidence because of the AIDS epidemic, and they are frequently associated with evidence of Pott's disease. When it is localized in a paraspinal location, a psoas abscess may be revealed by its effacement of the lateral border of the muscle and its lateral displacement of the kidney and ureter (Fig. 8220). CT and MR images show enlargement of the muscle with fluid collections, ring enhancement, and perhaps gas275-281 (Figs. 8-221 through 8-223).

Injection studies confirm clinical observations that the strong psoas fascia confines collections within it (Fig. 8-224). Indeed, this may provide a pathway for extension of the process to the hip and thigh (Figs. 8-225 and 8-226), as discussed in Chapter 17. Hemorrhage into the psoas muscle can be spontaneous (arteriosclerosis) or secondary to trauma, bleeding diathesis, anticoagulant therapy, inflammatory disease, tumor, or recent surgery or biopsy (Fig. 8-227).

Psoas Muscle Tumors

Fig. 8-220. Right psoas abscess secondary to osteomyelitis ofL2.

Intravenous urogram demonstrates mass density displacing the right kidney laterally and effacing the upper segment of the psoas muscle.

Iliopsoas Abscess Crohn Disease Psoas Muscle Tumors

Fig. 8—221. Psoas abscesses secondary to tuberculous infection.

(a) Contrast-enhanced CT shows bilateral central lesions of low attenuation with rim enhancement (arrows) in the psoas muscles.

(b) Sagittal gadolinium-enhanced fat-suppression MR image demonstrates the localized bilateral low-signal intensity psoas abscesses with rim enhancement (arrows).

(Reproduced from Torres et al.278)

Gas Filled Abcess

Fig. 8-222. Pyogenic psoas abscess secondary to fistulization from Crohn's enteritis.

(a) CT demonstrates a large fluid-filled abscess with small gas loculi and contrast material within the enhancing rim of the left psoas and iliopsoas muscles.

(b) At a lower level, a fistula between the bowel involved by Crohn's disease and the iliopsoas muscle (arrow) is revealed.

(Reproduced from Torres et al.278)

Fig. 8-222. Pyogenic psoas abscess secondary to fistulization from Crohn's enteritis.

(a) CT demonstrates a large fluid-filled abscess with small gas loculi and contrast material within the enhancing rim of the left psoas and iliopsoas muscles.

(b) At a lower level, a fistula between the bowel involved by Crohn's disease and the iliopsoas muscle (arrow) is revealed.

(Reproduced from Torres et al.278)

Hrerbunker Dead

Fig. 8-223. Pyogenic psoas abscess after graft infection.

Contrast-enhanced CT demonstrates an abscess of the right psoas muscle (large arrow), consequent to graft infection developing after a recent aortofemoral graft. The latter is indicated by periaortic and mesenteric inflammatory changes and adenopathy (small arrows). (Reproduced from Torres et al.278)

Fig. 8-223. Pyogenic psoas abscess after graft infection.

Contrast-enhanced CT demonstrates an abscess of the right psoas muscle (large arrow), consequent to graft infection developing after a recent aortofemoral graft. The latter is indicated by periaortic and mesenteric inflammatory changes and adenopathy (small arrows). (Reproduced from Torres et al.278)

Periaortic Inflammation

Fig. 8-224. Contrast injection into the psoas muscles.

The collections are restrained by the strong psoas fascia.

Fig. 8-224. Contrast injection into the psoas muscles.

The collections are restrained by the strong psoas fascia.

Iliopsoas Abscess Images

Fig. 8-225. Iliopsoas abscess.

(a—c) CT shows a gas-producing infection of the iliopsoas muscle tracking to a large abscess in the groin.

Fig. 8-225. Iliopsoas abscess.

(a—c) CT shows a gas-producing infection of the iliopsoas muscle tracking to a large abscess in the groin.

Psoas Abscess

Fig. 8-226. Tuberculous psoas abscess and Pott's disease with inguinal extension.

(a) Contrast-enhanced CT shows an extensive fluid collection with ring enhancement (white arrow) in the left psoas muscle adjacent to associated vertebral bone destruction and extension to the epidural space (black arrow). The left kidney is displaced anteriorly and laterally.

(b) The abscess extends down the iliopsoas compartment to the left inguinal area (arrows). (Reproduced from Torres et al.278)

Fig. 8-226. Tuberculous psoas abscess and Pott's disease with inguinal extension.

(a) Contrast-enhanced CT shows an extensive fluid collection with ring enhancement (white arrow) in the left psoas muscle adjacent to associated vertebral bone destruction and extension to the epidural space (black arrow). The left kidney is displaced anteriorly and laterally.

(b) The abscess extends down the iliopsoas compartment to the left inguinal area (arrows). (Reproduced from Torres et al.278)

Fig. 8—227. Psoas hematomas and aortoenteric fistula from ruptured abdominal aortic aneurysm.

Contrast-enhanced CT demonstrates gross rupture of an aortic aneurysm with bleeding extending to the psoas muscles (white arrows) and a duodenal clot (black arrows) from an aortoenteric fistula. (Reproduced from Torres et al.278)

Hematoma Fistula

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Responses

  • Ana
    What is psoas hematoma?
    6 years ago
  • silke
    What is rim enhancing collection in psoas muscles?
    1 year ago
  • AAMOS
    How to code a hematoma to the right psoas?
    1 month ago

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