Abscess, cold (ab"ses). A cold abscess is an abscess that
commonly accompanies tuberculosis. It develops so slowly that there
is little inflammation, and it becomes painful only when there is
pressure on the surrounding area. This type of abscess may appear
anywhere on thr body,but it is most commonly found on the spine,
hips, lymph nodes, or in the genital region.
Radiologicaly there may be erosion of bone local to the abscess, or
evidence of organ compression.
A sinogram will demonstrate the extent of the abscess.
Plain radiographs occasionally show a blurring or
indistinctness of the lateral margins of the psoas muscle but, in
general, are not as helpful as other techniques. Ultrasonography is
useful in showing
enlarged psoas muscle with hypoechogenic masses, however it is not
as accurate as a CT scan in showing the abscess. MRI is
advantageous because multiple processes can be evaluated.
Although primary psoas abscess is very rare in children of
"developed" countries, it is not rare in tropic and sub-tropical
"third world" countries with poor socioeconomic conditions.
Staphylococcus aureus is the most frequent type of infection seen in
these environments, with almost all children presenting with the
triad of pyrexia, flank pain and hip symptoms.
Psoas abscess can be a secondary problem associated with tuberculous
spondylitis or in relation to inflammatory bowel disease (1). More
recently, in the United States, psoas abscesses have been seen
secondary to transperitoneal low-velocity gunshot wounds to the
spine (3), or gastrointestinal or genitourinary trauma (2). Primary
psoas abscess can
be seen in patients with sickle cell disease, intravenous drug
users, immunocompromised individuals or individuals positive for
Drainage of the abscess by CT-guided percutaneous catheter has been
recommended by some, while surgical drainage is recommended by
others, especially when percutaneous catheter drainage is not
successful, followed by appropriate antibiotic therapy.
Sinigram of a "cold abscess"