CASE REPORT   

Il Giornale Italiano di Radiologia Medica 2018 Novembre-Dicembre;5(6):743-6

DOI: 10.23736/S2283-8376.18.00122-5

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: Italian

Multislice-CT in a rare case of ileopsoas muscle abscess due to unremarkable renal lithiasis

Anna ROTUNDO ✉, Valentina SETTINO, Angela TETI, Domenico LAGANÀ

Unità Operativa di Radiologia, Università “Magna Graecia” di Catanzaro, Catanzaro, Italia

Chronic pyelonephritis/perinephritis caused by lithiasis and complicated by Proteus Mirabilis superinfection is a rare clinical condition; its progression to abscess of ileopsoas muscle is even more rare. Moreover, the symptomatology of ileopsoas muscle abscess is very non-specific and this aspect does not help to achieve a rapid diagnosis that would be necessary for an adequate treatment. Surgical drainage and long term antibiotic treatment are key factors to achieve healing. We describe a case of a 49 years old woman with an unremarkable history, who went to the emergency room for a worsening walking problem associated to an abdominal swelling localized on the left side. Abdominal CT exam, first plain and then with iodinated contrast medium administered by intravenous bolus, showed a large formation with thick walls and 27 cm diameter, partially fluid but even solid with calcifications in the lower part, characterized by contrastographic enhancement after administration of contrast medium, compatible with an ileopsoas muscle abscess. Signs of left pyelonephritis/perinephritis were evident because of a renal structure completely disrupted. A percutaneous drainage established that the microorganism involved was Proteus Mirabilis. The patient was first treated with antibiotic and then, after assessment of left kidney function, by nephrectomy. In conclusion, the diagnosis of ileopsoas muscle abscess is not easy owing to the non-specific nature and low incidence of this kind of lesion: furthermore, in this case the situation was caused by the presence of a chronic pyelonephritis/perinephritis due to an unremarkable lithiasis. A thorough clinical assessment and a proper use of imaging led to an appropriate diagnosis.

KEY WORDS: Psoas muscles - Pyelonephritis - Tomography, X-ray computed