Psoas Abscess: A Primer for the Internist

, Department of Internal Medicine, Lincoln Health Center and Durham Regional Hospital, Durham, NC

South Med J. 2001;94(1) 

In This Article

Epidemiology

In 1992, the worldwide reported occurrence of psoas abscess was 12 cases per year.[1] This was a significant increase from the calculated occurrence of 3.9 cases per year before 1985. The increase was attributed to improved diagnosis with the widespread use of computed tomography (CT).[1,2] It is likely that incomplete reporting, particularly in the developing world, spuriously lowered the incidence. Up to 1985, all the cases of psoas abscess reported in developing countries were primary, whereas in the United States and Canada nearly 50% of cases were secondary.[1] Earlier reports suggested that primary psoas abscess was more common in younger patients, with 83% of cases diagnosed in patients less than age 30. In contrast, up to 40% of secondary psoas abscesses were diagnosed in patients more than 40 years old. Primary and secondary psoas abscesses were relatively rare in the elderly.[1] This age distribution is different from the findings in a recent series of 18 patients from Johns Hopkins University School of Medicine. In this series, researchers found secondary psoas abscess (age range, 2 to 78 years) to be more prevalent (61%) than primary psoas abscess (age range, 27 to 81 years). It is notable that 28% of the patients were over the age of 65. Of the patients with primary psoas abscess, 86% were intravenous drug users, and 57% were infected with the human immunodeficiency virus (HIV). None of the patients with secondary psoas abscess had HIV infection or a history of intravenous drug abuse. It is possible that the incidence of primary psoas abscess will increase with the HIV pandemic.[3] Other predisposing conditions include diabetes, immunosupression, and renal failure.[4] Underlying diseases in patients with secondary psoas abscess are shown in Table 1 .

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