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Psoas abscess is a collection of pus in the iliopsoas muscle compartment. [1] [2] It can be classified into primary psoas abscess (caused by hematogenous or lymphatic spread of a pathogen) and secondary psoas abscess (resulting from contiguous spread from an adjacent infectious focus). [2] Psoas abscess may be caused by lumbar tuberculosis.
The psoas sign, also known as Cope's sign (or Cope's psoas test [1]) or Obraztsova's sign, [2] is a medical sign that indicates irritation to the iliopsoas group of hip flexors in the abdomen, and consequently indicates that the inflamed appendix is retrocaecal in orientation (as the iliopsoas muscle is retroperitoneal).
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The final structure of the abscess is an abscess wall, or capsule, that is formed by the adjacent healthy cells in an attempt to keep the pus from infecting neighboring structures. However, such encapsulation tends to prevent immune cells from attacking bacteria in the pus, or from reaching the causative organism or foreign object.
CT with IV contrast showing enlargement and heterogeneous hypodensity in the right pectoralis major muscle. A focal abscess collection with gas within it is present medially. There are enlarged axillary lymph nodes and some extension into the right hemithorax. Note the soft tissue and phlegmon surrounding the right internal mammary artery and vein.
Sometimes, with a very flexible patient, the Thomas test will be normal despite a psoas dysfunction being present. However, in the patient with a normal hip joint, a positive test is a good indicator of psoas hypertonicity. [2] Other signs from the Thomas test: opposite/ contralateral hip flexes without knee extension- tight iliopsoas
Abscess A phlegmon is a localized area of acute inflammation of the soft tissues. It is a descriptive term which may be used for inflammation related to a bacterial infection or non-infectious causes (e.g. pancreatitis ).
A cold abscess can develop if infection spreads to ligaments and soft tissues. [6] [3] In the lower back, there is a chance the abscess can move down along the psoas muscle to the upper thigh and eventually break through the skin. [3]