Kudos to dzeccola for an accurate, succinct, and incredibly prompt answer to this clinical conundrum.
To review: We have a 49 year old man with pain on/inability to flex the right hip with concomitant fever and weight loss.
What is your next diagnostic step?
You can see a large, loculated mass overlying the R psoas muscle extending up, and possibly originating from, the R renal pelvis.
Treatment?
Pathophysiology?
The infection can be hematogenous (primary) versus contiguous spread (secondary, from GI, msk, or GU sources).
Risk factors include IV drug use (more likely primary/hematogenous), HIV, DM, Renal failure, other sources of immunosuppression.
Staph is the usual causative organism identified in about 80% of case. Other causative organisms that need to be considered are Psuedomonas, Serratia, Proteus, Haemophilus, enterics. Special considerations for TB/syphilis.
Common presenting symptoms?
Insidious onset – May present several times, may seek treatment through primary care before being see in the ED
Typically, hip, back, or abdominal pain, usually presenting with some systemic symptoms such as malaise, subjective fever, weight loss, night sweats
By Dr. Andrew Kopping and Dr. Andrew Grock
References:
Tintinalli’s Emergency Medicine Chpt 278 “Hip and Knee pain”
Medscape “Psoas Abscess: A Primer for the Internist” http://www.medscape.com/viewarticle/410693
UpTo Date “Psoas Abscess” http://www.uptodate.com/contents/psoas-abscess
andygrock
- Resident Editor In Chief of blog.clinicalmonster.com.
- Co-Founder and Co-Director of the ALiEM AIR Executive Board - Check it out here: http://www.aliem.com/aliem-approved-instructional-resources-air-series/
- Resident at Kings County Hospital
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