Case Reports
Retrofascial Bilateral Psoas Abscess in a 6-Year-Old Child
Am J Orthop. 2007 October;36(10):E141-E143
Author and Disclosure Information
Cláudio Santili, MD, Miguel Akkari, MD, Gilberto Waisberg, MD, Clóris Kessler, MD, and Susana dos Reis Braga, MD
Dr. Santili is Associate Professor, Santa Casa São Paulo–Faculty of Medical Sciences, and Chief, Pediatric Orthopedics and Traumatology Group, Irmandade da Santa Casa de Misericódia de São Paulo, São Paulo, Brasil.
Dr. Akkari is Instructor, Santa Casa São Paulo–Faculty of Medical Sciences, and Medical Assistant, Pediatric Orthopedics and Traumatology Group, Irmandade da Santa Casa de Misericódia de São Paulo, São Paulo, Brasil.
Dr. Waisberg is Postgraduate Fellow, Santa Casa São Paulo– Faculty of Medical Sciences; Medical Assistant, Pediatric Orthopedics and Traumatology Group, Irmandade da Santa Casa de Misericódia de São Paulo; and Chief, Pediatric Orthopedics, Faculdade de Medicina da Fundação do ABC, São Paulo, Brasil.
Dr. Kessler is Medical Assistant, and Dr. Reis Braga is Medical Assistant, Pediatric Orthopedic and Traumatology Group, Irmandade da Santa Casa de Misericordia de São Paulo, São Paulo, Brasil.
Abstract not available. Introduction provided instead.
Retrofascial abscess of the psoas muscle was first described by Herman and Mynter in 1881 and is considered a rare disease.1-5 Possible etiologies for the primary form of the disease are trauma, skin infection, lymph node suppuration, and nutritional and socioeconomic factors; the secondary form results mainly from Crohn’s disease or tuberculosis.1,2,6-8
Classic features of the disease are a triad of insidious installation of flank pain, limping, and flexion contracture of the ipsilateral hip, normally accompanied by consumptive signs and symptoms.1,2,6,9,10 Among the differential diagnoses are hip and sacroiliac septic arthritis, lymphadenitis, lymphoma, pelvic inflammatory disease, osteomyelitis of the spine, sarcoma on the thigh,1 psoas and retroperitoneal tumors,11,12 hematoma of the psoas,13 and avascular necrosis of the hip.
Ultrasonography and computed tomography (CT) are the main, complementary examinations used to diagnose the disease.1,4,6,14-18 Treatment consists of percutaneous puncture or open drainage, followed by appropriate antibiotic therapy.1,6,9,12,19
Prognosis is good, even though mortality rates are 2.5% for the primary form, 20% for the secondary form, and up to 100% in cases of late diagnosis and inadequate treatment.3,4,8,20
In this article, we present the case of a 6-year-old boy with bilateral psoitis. Psoitis affects both muscles simultaneously in less than 1% of cases; approximately 500 cases have been reported worldwide.8,21