Tuberculous Abscess of the Psoas Muscle in a Patient with Acute Lumbar Burst Fracture: A Missed Diagnosis

Abstract

The authors present a rare case of tuberculous spondylitis and a large abscess in the left psoas muscle that occurred after spinal surgery for an acute traumatic burst fracture of the L2 vertebral body. We retrospectively reviewed the patient's first magnetic resonance imaging (MRI) we found that some unusual findings, indicative of psoas abscess had been overlooked. As a result, diagnosis and treatment of tuberculous psoas abscess and spondylitis were considerably delayed. Despite the critical condition of patients in a similar emergency, surgeons should always pay close attention to the radiological findings and clinical symptoms of the patient before considering a surgical intervention or biopsy.

Keywords: Psoas abscess; Spondylitis; Tuberculosis.

Fig. 1. (A) Preoperative sagittal lumbar computed tomography scan with bone window settings showing burst fracture of the L2 vertebral body with displacement of a posterior fragment into the spinal canal. (B) Preoperative sagittal lumbar STIR magnetic resonance imaging showing acute burst fracture with retropulsion of the posterior bone fragment at the L2 vertebral body and acute compression fracture of the L1 vertebral body. (C) Postoperative lateral radiograph of the lumbar spine showing posterior fixation with pedicular screws and anterior reduction accomplished with a distractible cage and a MACS-TL plate (Aesculap, Tuttlingen, Germany).

Fig. 2. Coronal (A) and axial (B) abdominopelvic computed tomography scan showing the presence of a large abscess in the left psoas muscle, lower pole of the left kidney, and posteriolateral abdominal wall. Communication at all abscess sites can be seen.

Fig. 3. (A, B) Preoperative axial magnetic resonance imaging (MRI) of the L2 vertebra at the time of the first admission showing irregular shaped and ill-defined heterogeneously enlargement of the left psoas muscle compared to the right psoas or both paraspinal muscles. (C) Coronal T2-weighted MRI showing a thick line of high-signal intensity along the left psoas muscle (asterisk).