Rapid pulmonary fistulization complicating a psoas abscess with intraoperative hypoxemia: a rare case report

Abstract

Introduction and importance: Psoas abscess is a relatively uncommon condition that can present with vague clinical features. Patients with this condition often present in different ways to different specialties leading to delays in diagnosis and management.

Case presentation: The authors present a 47-year-old woman with complaint of vague abdominal pain, fever, and raised inflammatory markers who underwent CT examination. On CT, a collection was noted in the right iliac fossa that extended along the right retroperitoneum through the retrocrural space in the right lung base communicating with a cavitary pulmonary lesion with air-fluid level. The psoas abscess was drained.

Clinical discussion: Our case presents a number of rare and intriguing features. Notably, the patient, who was immunocompetent, experienced a primary Staphylococcus infection that swiftly progressed to a sizable pulmonary abscess, a phenomenon uncommon in such hosts. The rarity further extends to the source of infection, originating abdominally but culminating in thoracic complications through contiguous spread from a retroperitoneal site. Despite the potential severity, the patient's outcome was remarkably positive.

Conclusion: This case underscores the potential rapidity of pulmonary involvement in psoas abscesses, emphasizing the need for heightened awareness and consideration of respiratory signs during preoperative assessments.

Keywords: anesthesia; fistulization; hypoxemia; lung abscess; psoas abscess.

Figure 1

Preoperative CT scan imaging showing a psoas abscess measuring 75 mm in its long axis, with minial condensation at the right lung basis.

Figure 2

Postoperative CT scan imaging showing a psoas abscess, with right lung fistulization:. A. Parenchymal window of a cross-sectional image of thoracic CT illustrating fistulization of psoas abscess into pulmonary parenchyma. B. Mediastinal window of a cross-sectional image of thoracic CT illustrating fistulization of psoas abscess into pulmonary parenchyma. C. Pelvic CT scan revealing a right paravertebral hypodense collection measuring 75 mm in its long axis, accompanied by pubic osteitis. D. Abdominal CT scan demonstrating a right paravertebral hypodense collection containing air bubbles, with enhanced wall after contrast agent injection.