Psoas Abscess: A Diagnostic Dilemma

Abstract not available. Introduction provided instead.

Iliopsoas muscles are located in the retrofascial space, which lies between the transversalis fascia and the posterior psoas fascia.¹ Abscesses of the iliopsoas
result most commonly from osseous sources, such as the spine, ileum, and sacroiliac joint. They seldom arise from pyomyositis, trauma, lymphatic spread, or puerperal infections. Immunocompromised patients and drug users are particularly susceptible.

Iliopsoas abscess may initially present with signs and symptoms in the buttock, hip, or thigh. Such signs and symptoms may be obscure, nonspecific, and misleading.¹ Diagnosis is often overlooked, as a patient lies supine and refuses to move or resists being turned for examination. With psoas involvement, the hip is flexed and has a limited and painful range of motion that diverts attention from the abdominal or pelvic source of the abscess.² Pain is referred along the distribution of the gluteal or obturator nerves or along the distribution of the lumbar and sacral nerve roots, thus directing attention elsewhere.² The abscess may also be overlooked given the deep location of the iliopsoas muscle.³ Iliopsoas abscess is best detected through use of computed tomography (CT), which defines its pathway and allows for appropriate surgical treatment.