A rare case of renal squamous cell carcinoma presenting with psoas sign.

INTRODUCTION: Renal cancer is a relatively common form of cancer; however, squamous cell carcinoma of the kidney is extremely rare and it carries poor prognosis. CLINICAL PRESENTATION: We present a rare case of renal squamous cell carcinoma that was manifested with the psoas sign in a patient with a history of chronic staghorn calculus. DISCUSSION: Squamous cell carcinoma of kidney is rare and more invasive. Even though many risk factors have been identified, staghorn renal calculi with chronic infection have a higher incidence of renal squamous cell carcinoma (SCC). Squamous cell carcinoma (SCC) has a wider range of atypical presentations; the psoas sign is not commonly reported in other literature. Due to the lack of reporting and sufficient knowledge, there are currently no established management guidelines. Despite advancements in contemporary medicine, the survival rate of renal SCC remains remarkably low, necessitating further research to develop a standardized treatment protocol. CONCLUSION: Primary renal SCCs are rare tumors and exhibit a strong association with renal stones, requiring prompt assessment and treatment of renal stones in affected patients. Despite their aggressiveness and poor prognosis, timely intervention is crucial.

Cohort study on the relationship between morphologic parameters of paravertebral muscles, BMI and lumbar lordosis on the severity of lumbar stenosis.

INTRODUCTION: There is a growing body of literature separately linking lumbar spinal stenosis (LSS) with various factors such as paravertebral muscle (PVM) impaired function/morphology, lordosis or BMI. However, their interplay is yet to be known. The present study aims to investigate the relationship between PVM morphology, BMI and lumbar lordosis in a population with a surgical indication for LSS. MATERIALS AND METHODS: A cross-sectional retrospective study was conducted on a group of 122 patients diagnosed with LSS in a hospital setting and scheduled for spine surgery. Epidemiological data and body mass index (BMI) were gathered. The cross-sectional area of the psoas muscle (rCSA) at the L4-L5 disc level on preoperative axial T2 MRI was measured. Fat infiltration of the anterior (APVM) and posterior paravertebral muscles (PPVM) was evaluated according to Goutallier classification while the severity of lumbar stenosis was staged according to Schizas criteria. Lumbar lordosis was measured on sagittal MRI using Cobb's angle method. The presence of the "rising psoas" sign was also noted. Statistical analysis of the data was performed using Pearson and Spearman correlations. RESULTS: Statistical analysis revealed a moderate correlation between the severity of LSS and BMI (p = 0.001), and fatty infiltration of paravertebral muscles (p = 0.000, p = 0.000). Adjusting for age, gender, and BMI resulted in a low correlation (p = 0.003, p = 0.045), rCSA correlated negatively with age, gender, and lordosis. BMI had a low positive correlation with lumbar lordosis (p = 0.006), severity (p = 0.001), number of levels (p = 0.005) and PPVM (p = 0.031). CONCLUSIONS: This study highlighted the relationship between PVM morphology and the severity of radiological signs in patients with LSS undergoing spine surgery and found a correlation independent of age, gender, and BMI. BMI was also shown to correlate with the severity after controlling for age and gender. rCSA has limited use in evaluating the severity of LSS.

Iliopsoas Pyomyositis With Bacteremia at an Early Stage of Presentation in a Temperate Region.

A psoas abscess, a collection of pus in the psoas muscle, is rare but the incidence is increasing with the use of computed tomography (CT) and magnetic resonance imaging (MRI). Pyomyositis, a muscular infection that does not lead to abscess formation, is well known as tropical pyomyositis because it is highly prevalent in tropical areas. We encountered a case of iliopsoas pyomyositis and bacteremia without abscess formation. The blood culture was positive despite the early stage of presentation and no abscess formation on MRI. Imaging is the gold standard for diagnosing iliopsoas abscesses. There are cases similar to ours wherein the blood culture is positive before the formation of an abscess. Regardless of whether an abscess is found on MRI or not, we need to consider the possibility of false negatives at the early stage of presentation. A suspicion of this disease is essential during a physical examination for early diagnosis and treatment, especially in rural areas, where medical resources are limited. Furthermore, pyomyositis is a common disease in tropical regions, but in recent years, case reports of occurrences in temperate regions have increased. This case indicates the need to consider pyomyositis as a differential diagnosis of fever and hip joint pain even in temperate regions.

Methicillin-Sensitive Staphylococcus aureus Pyogenic Iliopsoas Abscesses: A Case Series from Jodhpur, India.

Early recognition of iliopsoas abscess is important for limiting morbidity and mortality. Mycobacterium tuberculosis remains an important cause of iliopsoas abscess in developing countries and most patients are initiated on empirical anti-tubercular therapy. In this context, methicillin- sensitive Staphylococcus aureus (MSSA) as a cause of iliopsoas abscess is rare in India. Four cases were diagnosed with pyogenic iliopsoas abscesses caused by MSSA. Half of the patients had a typical clinical triad of fever, difficulty in walking and backache. Primary iliopsoas abscesses were present in three patients. All patients were managed with percutaneous drainage and antibiotics with a favourable outcome. MSSA as a cause of primary iliopsoas abscesses is rare in India. Early diagnosis of microbial aetiology also minimizes the non-judicial use of antibiotics and anti-tubercular therapy.