Primary psoas abscess results from hematogenous spread from occult infection or local trauma with resultant intramuscular hematoma formation which predisposes an individual to an abscess formation. Secondary psoas abscess is often caused by a mixed flora of enteric bacteris (commonly e-coli or Myobacterium tuberculosis [TB]). Conditions associated with secondary psoas abscess include Crohn's disease, diverticulitis, appendicitis, colorectal cancer, urinary tract infection, vertebral osteomyelitis, and history of instrumentation around the spine.
signs and symptoms
- Classic triad of fever, back pain, and psoas spasm
- Pain in the flank, groin, or anterior thigh
- Malaise, weight loss, nausea
- Loss of appetite or other GI upset
- Antalgic gait
- Palpable, tender mass in inguinal area
- Severe pain with passive hyperextension of hip
- Severe pain with active, resisted abdominal flexion
- Injection Drug Use
- Renal Failure
- Hematologic Malignancy
- Males <20 years and low socioeconomic status
- Heel Tap
- Hop Test
- Iliopsoas muscle test
- Palpate iliopsoas muscle
- Obturator muscle test
- Vaz AP, Gomes J, Esteves J, Carvalho A, Duarte R. A rare cause of lower abdominal and pelvic mass, primary tuberculous psoas abscess: a case report. Cases J. 2009;2:182.
- Tomich EB, Giustina DD. Bilateral Psoas Abscess in the Emergency Department: a case report. Western Journal of Emergency Medicine. 2009;X (4):288-291.
- Dutton M. Orthopaedic Examination, Evaluation, and Intervention. 2 ed: McGraw-Hill, Medical Publishing Division; 2008.
- Goodman CC, Snyder TK. Differential Diagnosis for Physical Therapists: Screening for Referral. 4th ed: Saunders Elsevier, St. Louis, MO; 2007.