Ilio-Psoas Tuberculosis

Topic Name Introduction Clinical Presentation Diagnosis Management Complications

Introduction

Ilio-psoas tuberculosis is a rare form of musculoskeletal tuberculosis affecting the ilio-psoas compartment. It accounts for approximately 4.1% of musculoskeletal tuberculosis cases in children. The condition can occur as a primary infection or secondary to spinal tuberculosis.

Key Points

• Most common age group: 5-15 years
• Route of spread: Hematogenous or lymphatic
• Common association: Pott's disease (30-40% cases)
• Bilateral involvement: Seen in 15-20% cases

Pathophysiology

• Primary infection occurs through hematogenous spread
• Secondary infection commonly spreads from adjacent vertebral bodies
• Forms cold abscess within the muscle compartment
• Can track along the ilio-psoas sheath to various anatomical locations

Clinical Presentation

Common Symptoms

• Insidious onset of symptoms
• Progressive limping
• Hip flexion deformity
• Constitutional symptoms:
  • Low-grade fever
  • Weight loss
  • Night sweats
  • Decreased appetite
• Flank pain or abdominal pain
• Visible swelling in groin or thigh

Physical Examination

• Hip held in flexion
• Limited hip extension
• Psoas sign positive
• Palpable mass in iliac fossa
• Associated spinal tenderness in secondary cases
• Inguinal lymphadenopathy

Diagnosis

Laboratory Investigations

• Elevated ESR and CRP
• Lymphocytic predominance in blood count
• Mantoux test (TST): Usually strongly positive
• IGRA tests (optional)
• Aspirate analysis:
  • AFB staining
  • Culture and sensitivity
  • PCR for MTB
  • Histopathological examination

Imaging Studies

• Ultrasonography:
  • Initial screening tool
  • Shows hypoechoic collection
  • Guides aspiration
• MRI:
  • Investigation of choice
  • Shows exact extent of abscess
  • Identifies vertebral involvement
  • T2-weighted images show hyperintense collection
• CT Scan:
  • Delineates bone involvement
  • Guides intervention

Management

Medical Management

• Anti-tubercular therapy (ATT):
  • Initial intensive phase (2-3 months):
    • Isoniazid (H)
    • Rifampicin (R)
    • Pyrazinamide (Z)
    • Ethambutol (E)
  • Continuation phase (4-7 months):
    • Isoniazid (H)
    • Rifampicin (R)
• Duration: Minimum 6-9 months
• Regular monitoring of:
  • Liver function tests
  • Clinical response
  • Drug compliance

Surgical Management

• Indications:
  • Large abscess collection
  • No response to ATT
  • Neurological complications
• Procedures:
  • Ultrasound-guided aspiration
  • Catheter drainage
  • Open surgical drainage

Complications

• Hip joint involvement
• Residual hip flexion deformity
• Secondary infection
• Spread to adjacent structures
• Chronic sinus formation
• Drug resistance

Prevention of Complications

• Early diagnosis
• Regular physiotherapy
• Compliance with ATT
• Regular follow-up

Disclaimer

The notes provided on Pediatime are generated from online resources and AI sources and have been carefully checked for accuracy. However, these notes are not intended to replace standard textbooks. They are designed to serve as a quick review and revision tool for medical students and professionals, and to aid in theory exam preparation. For comprehensive learning, please refer to recommended textbooks and guidelines.