Iliopsoas abscess: a report of 24 patients diagnosed by CT

Background: We wanted to define the role of computed tomography (CT) in the diagnosis, etiology, and treatment of iliopsoas abscess. Methods: Twenty-four patients (18 men, six women; age range = 17-86 years) with iliopsoas abscesses diagnosed over 8 years were retrospectively review ed. All presented with fever and elevated white blood cell counts. Twenty-o ne had abdominal, flank or pelvic pain and nine had specific psoas signs su ggesting the diagnosis. Results: Seventeen of the abscesses were right-sided. Twenty were regarded as secondary to various underlying causes that were clearly demonstrated on CT and related to gastrointestinal (n = 12), skeletal (n = 5), or urinary tract (n = 3) diseases. All patients received appropriate antibiotic treatm ent. Thirteen also had their abscesses drained and eight had definitive sur gical procedures. Conclusion: CT is an effective imaging technique for diagnosing iliopsoas a bscess, even when classic clinical signs are absent. Treatment by percutane ous drainage under CT guidance is another advantage. When a psoas abscess i s a complication of Crohn's disease, resection of the affected bowel segmen t is recommended in addition to drainage because drainage alone even in con junction with appropriate medical therapy is usually not effective.