URORADIOLOGY


Case 3:
 
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A 31 year old female presents with right loin pain of 1 month duration.
What is the diagnosis?


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Imaging Findings

USG of the abdomen reveals normal echo and size of the right kidney. The right psoas was found to be bulky, a few bright echoes were noted within it. Suspecting a psoas abscess, a CT scan abdomen with lumbar spine was performed.
It revealed erosion and destruction of D12 and L1 vertebral bodies with bilateral psoas abscesses (see CT pic).

Diagnosis
Psoas abscess secondary to Koch's spine

Discussion
COLD ABSCESSES OF THE SPINE
Cold abscesses of the spine due to tuberculous involvement travel along paths which are determined by the anatomy of the area and can often be predicted by knowledge of this anatomy.
Position and Course of Cold Abscesses of the Spine in different areas:-
IN ANY AREA:
1)Prevertebral
2)Intraspinal (in the canal)

IN THE CERVICAL REGION:
1)Prevertebral:RETROPHARYNGEAL ABSCESS
2)At posterior border of the sternomastoid
3)In the mediastinum
4)At the back of the neck
5)In the axilla

IN THE THORACIC SPINE:
1)Prevertebral: in the posterior mediastinum
2)Along lateral lumbocostal arch, medial lumbocostal
arch or median arcuate ligament
3)Along the thoracic nerves

IN THE LUMBAR AREA:
1)Along the aorta or its branches
2) Psoas sheath or quadratus lumborum sheath
3)Along lumbar nerves
4)Extend between the flat muscles of the abdominal wall into Petit's triangle.


Contribution :Dr J Panjwani (MS, Orth), Mumbai.