What is the best diagnostic study for suspected iliopsoas abscess?

The Bottom Line:  Imaging studies can confirm the diagnosis early, and differentiation between primary and secondary type determines the most appropriate kind of treatment.

Reference: Charalampopoulos A, Macheras A, Charalabopoulos A, Fotiadis C, Charalabopoulos K.  Iliopsoas abscesses: diagnostic, aetiologic and therapeutic approach in five patients with a literature review.  Scand J Gastroenterol. 2009;44(5):594-9.

Summary: Five cases with iliopsoas abscess, treated during the past 10 years were analyzed retrospectively, with emphasis on the diagnostic and therapeutic approach to the disease.  Psoas abscess is an uncommon condition; at present it tends to be of non-tuberculous aetiology due to the decrease of tuberculosis in developed countries.

In relation to the diagnostic imaging studies used, the most frequent and useful image studied was the CT in all cases The US scan used in case 2, despite the diagnosis, failed to determine the exact location of the abscess. In the fourth case, where the main
symptom was long-standing fever of unknown origin, the abscess was diagnosed by a Gallium-67 scan and recent studies have shown important diagnostic use in demonstrating concomitant infectious sites.  As is shown in our cases (4 and 5) as well as in other short reports, assumed diagnosis may be delayed since the presenting features are non-specific, and in many instances misleading, necessitating a high degree of clinical suspicion and early resort to cross-sectional imaging using CT or MRI.

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