Can a Biomechanical Foot Orthosis Affect Gait in Patients With Hallux Valgus? A Pilot Study

Objective@#To investigate the effects of customized biomechanical foot orthosis (BFO) on kinematic data during gait in patients with hallux valgus (HV) deformities and compare the results with those of a normal control group. @*Methods@#Ten patients with HV deformities and 10 healthy volunteers were enrolled in this study. HV deformity was diagnosed using biomechanical and radiological assessments by a rehabilitation physician. Patients received the customized BFO manufactured at a commercial orthosis laboratory (Biomechanics, Goyang, South Korea) according to the strictly defined procedure by a single experienced technician. The spatiotemporal and kinematic data acquired by the Vicon 3D motion capture system (Oxford Metrics, Oxford, UK) were compared between the intervention groups (control vs. HV without orthosis) and between the HV groups (with vs. without orthosis). @*Results@#The temporal-spatial and kinematic parameters of the HV group were significantly different from those of the control group. After applying BFO to the HV group, significantly increased ranges of plantar flexion motion and hindfoot inversion were observed. Furthermore, the HV group with BFO showed improved gait cadence, walking speed, and stride length, although the results were not statistically significant. @*Conclusion@#Our results suggest that it is imperative to understand the pathophysiology of HV, and the application of customized BFO can be useful for improving kinematics in HV deformities.

Effect of Foot Orthoses in Children With Symptomatic Flexible Flatfoot Based on Ultrasonography of the Ankle Invertor and Evertor Muscles

Objective@#To examine the changes in the cross-sectional area (CSA) ratio of the ankle invertors and evertors following rigid foot orthosis (RFO) application in children with symptomatic flexible flatfoot and to determine the correlation between the degree of change in CSA ratio and pain-severity after RFO application. @*Methods@#We included 24 children with symptomatic flexible flatfoot without comorbidities and measured the CSAs of tibialis anterior (TA), tibialis posterior (TP), and peroneus longus (PL) using ultrasonography, resting calcaneal stance position (RCSP) angle, calcaneal pitch (CP), Meary’s angle, talonavicular coverage angle, and talocalcaneal angle using radiography, and foot function index (FFI) at baseline and 12 months after RFO application. We analyzed 48 data by measuring both feet of 24 children. The CSA ratios, the ratio of CSA of each muscle to the sum of CSA of TA, TP, and PL, were also compared. Correlations between the degree of change in FFI, each muscle’s CSA ratio, RCSP angle, and radiographic measurements were investigated. @*Results@#Following RFO application, significant increase in the PL ratio and CP and significant decrease in the RCSP angle, FFI total, pain, and disability scores were observed. The degree of change in the total score, pain, and disability score of FFI were significantly correlated with the degree of change in the PL ratio and RCSP angle. @*Conclusion@#RFOs applied to children with symptomatic flexible flatfoot might reduce the compensatory activities of the ankle invertors, thereby increasing the PL ratio, and pain decreases as the PL ratio increases.

Relationships Between Relative Ankle Muscle Ratios, Severity of Symptoms, and Radiologic Parameters in Adolescent Patients With Symptomatic Flexible Flat Feet

Objective@#To investigate differences in the relative sizes of the ankle-stabilizing muscles in individuals with versus without flexible flat feet and to determine predictors of symptom severity. @*Methods@#This cross-sectional study included 30 patients with symptomatic flexible flat feet and 24 normal controls. The following were evaluated: foot posture index, resting calcaneal stance position angle, radiographic findings (calcaneal pitch, Meary’s angle, talocalcaneal angle, talonavicular coverage angle [TNCA]), foot function index (FFI), and cross-sectional areas (CSA) of the tibialis anterior (TA), tibialis posterior (TP), and peroneus longus (PL) upon ultrasonographic examination. To address morphometric differences among participants, individual muscle measurements were normalized to proportions of total muscle CSA. Between-group differences were evaluated with independent t-tests. Correlations between muscle ratios, radiographic parameters, and FFI scores were investigated. Logistic regression analysis was performed to determine which parameters predicted severe symptoms. @*Results@#The relative size of the TP was significantly greater and those of the TA and PL were significantly smaller in patients with flat feet than in normal controls. Correlations were found among relative muscle CSA ratios, radiographic parameters, and FFI score. Linear regression analysis confirmed that the TNCA and the relative CSA of the PL were independent predictors of symptom severity. @*Conclusion@#This study found significant differences in the relative CSAs of the ankle muscles in patients with flexible flat feet versus individuals without flat feet; these differences were significantly correlated with anatomic abnormalities. Symptoms were more severe in patients with relatively greater forefoot abduction and relatively smaller PL.

Relationships Between Relative Ankle Muscle Ratios, Severity of Symptoms, and Radiologic Parameters in Adolescent Patients With Symptomatic Flexible Flat Feet

Objective@#To investigate differences in the relative sizes of the ankle-stabilizing muscles in individuals with versus without flexible flat feet and to determine predictors of symptom severity. @*Methods@#This cross-sectional study included 30 patients with symptomatic flexible flat feet and 24 normal controls. The following were evaluated: foot posture index, resting calcaneal stance position angle, radiographic findings (calcaneal pitch, Meary’s angle, talocalcaneal angle, talonavicular coverage angle [TNCA]), foot function index (FFI), and cross-sectional areas (CSA) of the tibialis anterior (TA), tibialis posterior (TP), and peroneus longus (PL) upon ultrasonographic examination. To address morphometric differences among participants, individual muscle measurements were normalized to proportions of total muscle CSA. Between-group differences were evaluated with independent t-tests. Correlations between muscle ratios, radiographic parameters, and FFI scores were investigated. Logistic regression analysis was performed to determine which parameters predicted severe symptoms. @*Results@#The relative size of the TP was significantly greater and those of the TA and PL were significantly smaller in patients with flat feet than in normal controls. Correlations were found among relative muscle CSA ratios, radiographic parameters, and FFI score. Linear regression analysis confirmed that the TNCA and the relative CSA of the PL were independent predictors of symptom severity. @*Conclusion@#This study found significant differences in the relative CSAs of the ankle muscles in patients with flexible flat feet versus individuals without flat feet; these differences were significantly correlated with anatomic abnormalities. Symptoms were more severe in patients with relatively greater forefoot abduction and relatively smaller PL.

Vitamin D Status according to the Diseases in Hospitalized Rehabilitation Patients: Single Center Study

To investigate vitamin D status according to the diseases in patients admitted to the department of rehabilitation medicine. In total, 282 patients admitted to the department of rehabilitation medicine in our hospital were included. Patients were classified into 4 groups according to ailment: stroke, traumatic brain injury, spinal cord injury, and fracture. All patients were also classified as ambulatory or non-ambulatory. Serum 25-hydroxyvitamin D (25[OH]D) levels were estimated at admission and at discharge. Bone mineral density (BMD) and ionized calcium levels were also measured. All subjects completed the Desmond Fall Risk Questionnaire for fall risk assessment. In total, 92 patients (59 males and 33 females; mean age, 69.09 ± 9.4 years) was enrolled. Low serum 25(OH)D levels (6–28 ng/mL) were observed in all patients in this study, and these were lower in the group of fractures resulting from falls than in the group of strokes (p < 0.05). Significant correlations were found between BMD and ionized calcium levels, Desmond Fall Risk Questionnaire scores and BMD, and questionnaire scores and serum 25(OH)D (p < 0.05). Serum 25(OH)D levels were lower in the department of rehabilitation medicine inpatients in our study than in the general population. The ambulatory patients had higher serum 25(OH)D levels at discharge than the non-ambulatory patients'. The hospitalized rehabilitation patients had lower serum 25(OH)D compared with the community. There were lower serum 25(OH)D levels in patients with fractures and non-ambulatory groups. We should pay attention to serum vitamin D levels of rehabilitation center inpatients.

Long-Term Effect of Rigid Foot Orthosis in Children Older Than Six Years With Flexible Flat Foot

OBJECTIVE: To evaluate the long-term effect of a custom-made rigid foot orthosis (RFO) in children older than 6 years with pes planus (flat foot). METHODS: Medical records of 42 children diagnosed with flexible pes planus who were fitted with RFOs based on the inverted technique and underwent more than four consecutive radiological studies were reviewed. Resting calcaneal stance position (RCSP), anteroposterior talocalcaneal angle, lateral talocalcaneal angle, lateral talometatarsal angle, and calcaneal pitch were initially measured in both feet to evaluate alignment. Followup clinical and radiological evaluations were then performed at 12–18, 24–30, 36–42, and ≥48 months after RFO application. Repeated measures analysis of variance was used to evaluate significant differences. RESULTS: Significant improvements in all radiological indicators and significant progression of RCSP toward the corrective direction were observed after RFO application relative to baseline measurements. CONCLUSION: According to our findings, RFO can induce significant improvements in calcaneus-related radiographic indices and subsequently improve talus-related radiologic indices.

Hand Functions of Myoelectric and 3D-Printed Pressure-Sensored Prosthetics: A Comparative Study

The loss of an upper limb significantly limits the functional activities of daily living. A huge emphasis is placed on the manipulation, shape, weight, and comfort of a prosthesis, to enable its use as an inherent body part. Even with technological advances, customized upper-extremity myoelectric prosthesis remain heavy and expensive. The high cost of upper-extremity prosthesis is an especially steep economic barrier for patients. Three-dimensional (3D) printing is a promising avenue for reducing the cost of prosthesis. We applied 3D-printed pressure-sensored prosthetics to a traumatic transradial amputee, and compared the hand functions with a customized myoelectric prosthesis. The 3D-printed pressure-sensored prosthetics showed low grip strength and decreased dexterity compared to the conventional myoelectric prosthesis. Although there were a few limitations, the fabrication of prosthesis with 3D printing technology can overcome previous problems such as high production cost, long fabrication period and heavy weight.

High Frequency Repetitive Transcranial Magnetic Stimulation for Freezing of Gait and Nonmotor Symptoms in Parkinson's Disease

BACKGROUND: To investigate the effect of high frequency repetitive transcranial magnetic stimulation (rTMS) on motor symptoms especially freezing of gait (FoG), and nonmotor symptoms in Parkinson disease (PD). METHODS: In this randomized, double-blind, sham-controlled study, fifteen PD patients were enrolled. For 10 days, 5 Hz, both motor cortices and dorsolateral prefrontal cortex (DLPFC) were stimulated. The motor symptoms and FoG were evaluated by the Unified Parkinson's Disease Rating Scale (UPDRS) part III, FoG questionnaire (FoG-Q), variable parameters of FoG, and kinematic gait analysis. Nonmotor symptoms were evaluated by the Korean version of non-Motor Symptoms Scale (K-NMSS), 39-item Parkinson disease questionnaire (K-PDQ39), Mini-Mental Status examination (K-MMSE), Montreal Cognitive Assessment (K-MoCA), and Frontal assessment battery (FAB). RESULTS: Finally, 12 patients (real:8, sham:4) data were analyzed. FoG-Q and UPDRS part III were improved (p=0.002, 0.022) and variable parameters of FoG was improved after 10 days stimulation in real treatment group. In addition, their effects maintained until 6 weeks from the baseline. In nonmotor symptoms, K-NMSS and K-PDQ 39 were improved until 6 weeks in real treatment group (p=0.002, 0.002), however no changes were shown in cognitive function test. CONCLUSIONS: The high frequency rTMS was effective for FoG, in addition to motor and a few nonmotor symptoms in PD.

Effects of Custom-Made Rigid Foot Orthosis on Pes Planus in Children Over 6 Years Old

OBJECTIVE: To identify the effects of a custom-made rigid foot orthosis (RFO) in children over six years old with pes planus. METHODS: The medical records of 39 children (mean age, 10.3+/-4.09 years) diagnosed with pes planus, fitted with RFOs, and had who more than two consecutive radiological studies were reviewed. The resting calcaneal stance position (RCSP), anteroposterior talocalcaneal angle (APTCA), lateral talocalcaneal angle (LTTCA), the lateral talometatarsal angle (LTTMA), and calcaneal pitch (CP) of both feet were measured to evaluate foot alignment. After diagnosis, children were fitted with a pair of RFOs and recommended to walk with heel strike and reciprocal arm swing to normalize the gait pattern. A follow-up clinical evaluation with radiological measurements was performed after 12-18 months and after 24 months of RFO application. Post-hoc analysis was used to test for significant differences between the radiological indicators and RCSP. RESULTS: With RFOs, all radiological indicators changed in the corrective direction except LTTCA. RCSP and CP in the third measurement showed significant improvement in comparison with the second and baseline measurements. Additionally, APTCA and LTTMA revealed improvements at the third measurement versus the baseline measurements. CONCLUSION: This study revealed that radiological indicators improved significantly after 24 months of RFO application. A prospective long-term controlled study with radiographical evaluation is necessary to confirm the therapeutic effects of RFOs and to determine the optimal duration of wear in children with pes planus.

The Effects of Changes of Ankle Strength and Range of Motion According to Aging on Balance

OBJECTIVE: To investigate the changes of ankle strength and range of motion with aging and which of the ankle strength and range of motion are contributed to balance. METHODS: Sixty healthy people (24 men and 36 women) have undergone tests for ankle strength and range of motion, using Biodex System 4 Pro; a one-leg balance, including postural sway and stability index using a Balance System; in which data were collected in a self-reported Desmond fall risk questionnaire. RESULTS: Participants are classified into 3 groups by age (group 1, 20-40 years; group 2, 40-65 years; group 3, over 65 years). Stability index and postural sway is significantly increased with aging. Ankle plantarflexor strength and ankle eversion range of motion is significantly decreased with aging. Pearson's correlation revealed that ankle plantarflexor strength is significantly correlated with anterior/posterior sway, and ankle eversion range of motion is significantly correlated with medial/lateral sway in the aged group (over 65 years). CONCLUSION: Stability, ankle plantarflexor strength, and eversion range of motion is declined with aging. In addition, strength of ankle plantarflexor and eversion range of motion is significantly correlated with balance stability. Further studies are needed for programs to improve the strength of plantarflexor, and range of motion of eversion of the ankle are beneficial in improving balance, stability, and prevention of falling in the elderly.

Recurrent Cerebral Infarction Caused by Mobile Aortic Arch Thrombus Refractory to Warfarin Therapy

The mobile thrombus in the aortic arch is a rare condition, which becomes rarer when associated with cerebral infarction, resulting in disabling complications. Transesophageal echocardiography is useful for detecting the source of thrombi in the heart and aortic arch. Here, we report a case of a patient who suffered from recurrent cerebral infarction four times during the previous 18 months due to mobile thrombus in the aortic arch despite anticoagulant therapy. The thrombus with rocking motion (9.6 and 8 mm) was laid in the top of the aortic arch, and surgical resection was not allowed due to the location. We began anticoagulation therapy initially with heparin followed by a combination of warfarin, aspirin, and atorvastatin with an international normalized ratio between 2 and 3. The size of the aortic thrombi was significantly decreased by 3 mm and stabilized after 18 months.

Autonomic Dysfunction after Traumatic Brain Injury

Patients following traumatic brain injury (TBI) sometimes display paroxysmal autonomic and muscle overactivity, which is suspicious to self-limiting or permanent disability. There are still no standard definition and diagnostic tools for autonomic dysfunction after TBI. Dysautonomia has been used as the most dominant term by authors of papers, was defined as simultaneous paroxysmal increases in at least five out of the seven features (heart rate, respiratory rate, blood pressure, temperature, posturing, dystonia and sweating) with episodes persisting for at least 2 weeks after injury. Heart rate variability (HRV) may be helpful to diagnosis the dysautonomia. The available evidence for managing of dysautonomia was intravenous morphine, Gabapentin, Bromocriptine and intrathecal baclofen infusion. Therefore, future efforts should be targeted at multicenter, large sample studies to make the diagnostic criteria and to evaluate the incidence, natural history and management of autonomic dysfunction after TBI.

Efficacy and Safety of Solifenacin Succinate for Urinary Difficulty in Brain Lesion: Multicenter Prospective Study

OBJECTIVE: We studied the efficacy and safety of solifenacin for urinary difficulty in brain lesion from multicenter prospective study. METHOD: Eighty patients with brain lesion who visited from 5 multicenter department of rehabilitation medicine from May 2009 to June 2010 were included. Patients were treated with solifenacin 5 mg to 10 mg for 12 weeks. The outcome measure was mean change in daily micturation frequency, daily frequency of incontinence, urgency episodes, and nocturia episodes from baseline to week 12. Patient's attitude to drug was assessed using the BSW Questionnaire (Benefit, Satisfaction and Willingness to Continue Questions). RESULTS: Sixty-one of 80 were evaluated for effect. All voiding parameters showed significant improvement after 12 weeks of treatment (p<0.05). There was no significant difference in efficacy of solifenacin between ischemic and hemorrhagic stroke. A twenty-two patients experienced 27 adverse events (AE). The most frequent AE were dry mouth (12.5%) and constipation (6.3%). Treatment related adverse events with solifenacin were mainly mild in severity, and only led to discontinuation in 6.3% of patients. CONCLUSION: Solifenacin succinate improve urinary difficulty symptoms with acceptable efficacy and safety in patient with brain lesion.

Effect of Lower Limb Strength on Falls and Balance of the Elderly

OBJECTIVE: To assess the effect of lower limb strength on falls and balance in community-dwelling elderly persons by a health status questionnaire, evaluation of lower limb strength and balance. METHOD: A total of 86 subjects (age 69.8+/-5.3) were categorized into one of two groups, "Fallers" and "Non-fallers". Thirty one participants who had reported the experience of having fallen unexpectedly at least once in the past year were assigned into the group "Fallers", and the remaining 55 subjects having no fall history in the past year, "Non-fallers". A self-assessment questionnaire was taken. Lower limb strength was measured by a "Chair stand test". Balance was measured by the stability index of the fall risk test protocol of Balance System SD(R) (Biodex, New York, USA). The differences between the two groups were compared and the correlation between lower limb strength and balance were analyzed. RESULTS: The questionnaire demonstrated no significant differences between two groups. The "Chair stand test" showed a significantly less for the "Fallers" (p<0.05). The stability index was significantly greater in the "Fallers" group (p<0.05). There was a moderate negative correlation between the "Chair stand test" and the "Stability index" (R=-0.576, p<0.01). CONCLUSION: This study suggests that the "Chair stand test" is a useful screening process for lower limb strength which correlates to risk for falls and balance in the elderly.

Delayed Onset of Thoracic SCIWORA in Adults

Spinal cord injury (SCI) without radiographic abnormality (SCIWORA) is estimated to account for 1-9% of the occurrence of SCI. Of these, cervical SCIWORA in children is common, but thoracic SCIWORA delayed onset in adult is much less common. We experienced a case of 38-years old male patient with lower extremity weakness; he had fallen down a week earlier before the investigation. At the time of admission, motor grade was 4 with voiding incontinence and ambulated with cane. He presented progressive weakness from G4 to G3 and hypoesthesia was below T8 dermatome and ambulated with wheelchair. Whole spine and lumbar MRI findings showed no abnormality and electrodiagnostic findings showed normal NCS, however, abnormal SEP on both the tibial nerves. After steroid therapy and proper rehabilitation program for 2 weeks, lower extremity strength was improved from G4 to G3, voiding was continent, and ambulation reached cane gait.

Urinary Difficulty in Brain Lesion: Impact on Quality of Life: Multicenter Prospective Epidemiologic Study

OBJECTIVE: To asses the prevalence of urinary difficulty and the relationship of urinary difficulty and type of brain lesion from multicenter prospective epidemiologic study. METHOD: 394 patients including outpatients and inpatients who visited from multicenter department of rehabilitation medicine from January 2008 to June 2008 were evaluated. Study based on international prostate symptom score (IPSS) and Quality of life (QoL) score were assessed, and the correlation between the two indexes was analyzed. RESULTS: 140 patients (35.5%) complained urinary difficulty as patient's main symptom, while IPSS score was 13.7 showing above moderate symptom at 77.5%. For patients complained urinary difficulty, the average of quality of life score was 3.1. Among stroke, 37% of infarction and 34% of hemorrhage complained urinary difficulty while 40% of traumatic brain injury did. Patients with ACA infarction reported urinary difficulty most frequently. Nocturia (71%), frequency (53.3%), incomplete emptying (30%) were the most frequent symptoms. Sixty-six patients (46%) complaining urinary difficulty were taking medications and anticholinergics were most widely used (75%). Scores of IPSS and QoL according to type and site of brain lesion didn't show meaningful difference while QoL score correlated significantly with IPSS score (p<0.05). CONCLUSION: Among all the brain lesion patients, 35.5% complained urinary difficulty while IPSS and QoL score according to type and site of brain lesion didn't show meaningful difference. Urinary difficulty affects the life quality of brain lesion patients.

Effect of Depressive Symptoms at Acute Stage on the Course of Disease Progression in Whiplash Patients

OBJECTIVE: To find out the effect of depressive symptoms at acute stage on the course of disease progression in whiplash patients. METHOD: Thirty-eight patients with neck pain after acute whiplash injury were enrolled. The patients were prospectively surveyed within 7 days after whiplash injury and followed up after discharge by telephone interview. Depressive symptoms, self-perceived disability from neck pain, and pain intensity were measured by Center for Epidemiological Studies-Depression Scale (CES-D), neck disability index (NDI), and visual analog scale (VAS), respectively. Depressive group was defined as CES-D scores more than 21. The correlation between duration of total treatment and CES-D score and other variables was investigated by calculating independent t-test, Pearson's correlation coefficient and linear regression analysis. RESULTS: The mean overall score of CES-D was 20.8+/-11.7 and 20 (52.6%) patients were classified as depressive group. Depressive group showed longer duration of total treatment (55.1+/-35.1 vs 38.9+/-16.4, p>0.05) and higher pain intensity after total treatment (37.0+/-21.3 vs 29.4+/-20.1, p>0.05) than non-depressive group, but statistical significance was not sufficient. Duration of total treatment was correlated with NDI score (gamma=0.454, p<0.01) and initial pain intensity (gamma=0.349, p<0.05), but not related with socio-demographic factors - age, gender, marital status - and CES-D score. CONCLUSION: Duration of total treatment was correlated with physical disability and initial pain intensity. Depressive symptoms at acute stage of whiplash injury was correlated with both of them. Depressive symptoms could affect the outcome of whiplash injury indirectly through pain intensity and physical disability.

Cerebral Air Embolism after Removal of Subclavian Venous Catheter: A case report

We experienced a patient who developed a cerebral air embolism after subclavian venous catheter removal. The patient underwent gastric antrectomy under impression of gastric cancer. After surgery, right subclavian venous catheter was removed while the patient was kept in supine position for 15 minutes. When he changed to sitting position, he became agitated and O2 saturation was dropped to 72%. Im-mediately 100% O2 was administered via air mask. Computed tomography of brain showed multiple focal air densities in the cerebral vessels. Three days after the event, he slowly regained consciousness with persistent left hemipareis. After rehabilitation, he was able to walk with quadcane and gained functional improvement.

The Effect of Hyperglycemia at Admission on Clinical Outcomes after Acute Stroke

OBJECTIVE: To clarify the issues about the importance of hyperglycemia in the acute stage of stroke as a poor predictor of clinical outcome, we analyzed the relationship between the glucose level in admission and clinical outcome in the acute stroke patients. METHOD: Twenty-five patients with sudden onset of acute stroke with focal neurological deficit were included in this study. Clinical assessments consisted of the National Institutes of Health Stroke Scale (NIHSS) for neurological impairment and the Korean modified Bathel index (KMBI) for functional status. NIHSS and K-MBI were assessed at admission and at discharge. Plasma glucose level was measured at admission in all patients. Acute hyperglycemia at admission was defined as fasting plasma glucose level more than 140 mg/dl. Statistical analysis were used to compare variables and clinical outcome scores between the normoglycemic and hyperglycemic groups. RESULTS: For the patient with hyperglycemia at admission, the odds ratio for neurological improvement decreased (beta=-0.604) and the odds ratio for functional improvement decreased (beta=-0.553). However, control of the glucose level during the acute stroke was not significantly related to neurological and functional recovery (p>0.05). CONCLUSION: In patients with acute stroke, hyperglycemia at admission was associated with neurological and functional impairments. Therefore, we expect that strict control of hyperglycemia during the acute stroke would improve clinical outcomes.

Iatrogenic Iliopsoas Abscess after Trigger Point Injection : A case report

After slip down, a 64 years old female had pain on the left buttock and the back without weakness or sensory change. Physical examination revealed tender points on left buttock and quadratus lumborum muscle. Straight leg raising test was 40degrees/20degrees. After trigger point injection on tender points, her symptoms were improved. Magnetic resonance imaging showed central extruded disc at L3-S1. After systemic steroid therapy was started, fever was developed about 39.3degrees C and laboratory evaluation showed inflammatory sign. Systemic steroid injection was stopped. Physical examination revealed a palpable and painful mass on the left lower quadrant of the abdomen. Ultrasonography and computerized tomography of abdomen and pelvis showed a large (7x5 cm) irregular shaped cystic mass along left iliopsoas muscle. Percutaneous catheter was inserted for drainage. Thick turbid yellow-greenish pus (300 cc) was drained. Intravenous antibiotics were administered and the patient's symptoms gradually improved. Culture of the pus revealed Streptococcus agalactiae.