Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지

Primary psoas abscess confused with hip pathology

고관절 이상으로 오인된 일차성 요근 농양 1례

  • Kim, Young Ok (Department of Pediatrics, Chonnam National University Medical School) ;
  • Woo, Young Jong (Department of Pediatrics, Chonnam National University Medical School)
  • 김영옥 (전남대학교 의과대학 소아과학교실) ;
  • 우영종 (전남대학교 의과대학 소아과학교실)
  • Received : 2006.01.06
  • Accepted : 2006.01.16
  • Published : 2006.05.15
Download PDF
⟨ Previous Next ⟩

Abstract

A healthy, 14-year-old boy presented with right hip pain and consequent fever after falling out of bed while sleeping. The patient could not walk and complained of severe pain with active and passive motion, which consisted mainly in extension and internal rotation of the right hip. Laboratory analysis of the peripheral blood identified leukocytosis and increased levels of acute phase reactants. Magnetic resonance imaging of the hip, which was performed with the expectation of right hip pathology, revealed cellulitis and abscess in the right psoas muscle and associated inflammatory changes in the adjacent presacral fat plane but showed no abnormal lesions in the adjacent pelvic bone and spine. Staphylococcus hominis was cultured from the blood. With empirical antibiotic therapy, the patient recovered fully. We report a case of primary psoas abscess confused with hip pathology in an immunocompetent child without underlying disease.

대요근은 12번 흉추의 외연면에서 5번 요추까지의 외연면에 걸쳐 기시하여 대퇴골의 소전자에 부착되는 근육으로 고관절의 굴곡에 관여한다. 이는 후복막 기관으로 여러 혈관에서 풍부한 혈류 공급을 받으며, S자 결장, 공장, 충수 돌기, 요관, 대동맥, 신장, 췌장, 척추, 림프선 등 여러 장기와 인접하고 있어 감염의 호발 부위가 된다. 그러나, 요근 농양 발생시, 그 증상이 비특이적이고 건강한 소아에서 드물게 발병하는 이유로 고관절 질환으로 혼돈되기도 하여, 진단과 치료가 지연되는 예가 많다. 저자들은 평소 건강하던 14세 남아가 침대에서 떨어져 경한 우측 둔부 좌상을 입은 이후, 우측 둔부 통증과 발열 및 보행 불능을 호소하여 고관절 이상을 의심해 시행한 자기 공명 영상에서 우연히 우측 요근내 농양을 발견해 항생제 치료를 시행하였던 증례를 경험하였기에 보고하는 바이다.

Keywords

References

  1. Mallick IH, Thoufeeq MH, Rajendran TP. Iliopsoas abscesses. Postgrad Med J 2004;80:459-62 https://doi.org/10.1136/pgmj.2003.017665
  2. Agrawal SN, Dwivedi AJ, Khan M. Primary psoas abscess. Dig Dis Sci 2002;47:2103-5 https://doi.org/10.1023/A:1019693400742
  3. Bresee JS, Edwards MS. Psoas abscess in children. Pediatr Infect Dis J 1990;9:201-6 https://doi.org/10.1097/00006454-199003000-00011
  4. Ricci MA, Rose FB, Meyer KK. Pyogenic psoas abscess : worldwide variations in etiology. World J Surg 1986;10:834-43 https://doi.org/10.1007/BF01655254
  5. Paley M, Sidhu PS, Evans RA, Karani JB. Retroperitoneal collections--aetiology and radiological implications. Clin Radiol 1997;52:290-4 https://doi.org/10.1016/S0009-9260(97)80056-6
  6. Isabel L, MacTaggart P, Graham A, Low B. Pyogenic psoas abscess. Aust N Z J Surg 1991;61:857-60 https://doi.org/10.1111/j.1445-2197.1991.tb00173.x
  7. Maull KI, Sachatello CR. Retroperitoneal iliac fossa abscess : A complication of suppurative iliac fossa lymphadenitis. Am J Surg 1974;127:270-4 https://doi.org/10.1016/0002-9610(74)90030-0
  8. Prassopoulos PK, Giannakopoulou CA, Apostolaki EG, Charoulakis NZ, Gourtsoyiannis NC. Primary ilio-psoas abscess extending to the thigh in a neonate : US, CT and MR findings. Pediatr Radiol 1998;28:605-7 https://doi.org/10.1007/s002470050427
  9. Wong JG. The psoas signs. Well-described but often forgotten physical examination findings of iliopsoas inflammation. N C Med J 1993;54:598-600
  10. Kadambari D, Jagdish S. Primary pyogenic psoas abscess in children. Pediatr Surg Int 2000;16:408-10 https://doi.org/10.1007/s003839900329
  11. Wu TL, Huang CH, Hwang DY, Lai JH, Su RY. Primary pyogenic abscess of the psoas muscle. Int Orthop 1998; 22:41-3 https://doi.org/10.1007/s002640050205
  12. Simon GW, Sty JR, Starshak RJ. Retroperitoneal and retrofascial abscess. A review. J Bone Joint Surg Am 1983;65: 1041-58 https://doi.org/10.2106/00004623-198365080-00004
  13. Kao PF, Tzen KY, Tsui KH, Tsai MF, Yen TC. The specific gallium-67 scan uptake pattern in psoas abscesses. Eur J Nucl Med 1998;25:1442-7 https://doi.org/10.1007/s002590050321
  14. Williams MP. Non-tuberculous psoas abscess. Clin Radiol 1986;37:253-6 https://doi.org/10.1016/S0009-9260(86)80330-0
  15. Gruenwald I, Abrahamson J, Cohen O. Psoas abscess : case report and review of the literature. J Urol 1992;147:1624-6 https://doi.org/10.1016/S0022-5347(17)37650-4
  16. Malhortra R, Singh KD, Bhan S, Dave PK. Primary pyogenic abscess of the psoas muscle. J Bone Joint Surg Am 1992;74:278-84 https://doi.org/10.2106/00004623-199274020-00014