DIAGNOSTIC AND THERAPY OF ABSCESSES OF TH E PSOAS

Problem: Psoas abscesses are really rare so that the diagnostic onset is commonly very late. The differential diagnosis to other retroperito neal processes is therefore important. Method: In a period of observat ion of 6 years 21 patient were treated with psoas abscesses. The evalu ation of 16 records was done retrospectively under consideration of et iology, history, clinical examination, lab results and x-ray/CT/MRI et c. Results: With the knowledge of the anatomy of the iliopsoas muscle the clinical examination gives us important information about the diag nosis of psoas abscess. The history and the clinical examination prece ed the further diagnostics and are condition for high rates of sensiti vity and specifity. Lab results indicate an absedation without being s pecific. The exclusive position of radiological diagnostics is undispu ted. Ultrasound, x-ray and leucocyte marked bonescan are proven to be helpful in cases of unknown location of the abscess. Method of choice seems to be the contrast enhanced CT- scan. The differential diagnosis includes gastrointestinal or renal disorders as well as pathology of bone or joints. In our cases differential diagnosis was complicated si nce the diagnostic onset was delayed and the initial therapy was not a dequate. The diagnosis ''abscess of the psoas'' does not imply a gener al regime for therapy therefore an individual treatment in considerati on of percutaneous and operative drainage has to be recommended. In se lected cases a combination therapy is adviced. Conclusion: In every ca se of retroperitoneal symptoms the differential diagnosis of an absces s of the psoas has to be regarded. The diagnosis is subtil and require s clinical and laboratory examinations as well as contrast enhanced co mputerscan. The therapy follows operative measures. The technique has to be individually decided.