Medical management of psoas muscle deep endometriosis: A case report.

Endometriosis is a common gynaecological pathology characterized by the presence of endometrial tissue outside the uterine cavity, and the most frequent locations of endometriosis are ovaries and posterior compartment of the pelvis. In this paper we report the case of a rare bilateral endometriosis location of posas muscle diagnosed and treated in a 25-year-old patient. This is the third case of psoas endometriosis location reported, but the first one successfully treated by hormone estrogen-progestogen treatment alone. Psoas endometriosis is a rare location and the medical management in first line can be an alternative to surgery and provide optimal patient relief.

Xanthogranulomatous pyelonephritis with calculus migration into the psoas abscess: an unusual complication

Xanthogranulomatous pyelonephritis (XGP) is a rare variant of chronic pyelonephritis. It is characterized by progressive parenchymal destruction caused by chronic renal obstruction due to calculus, stricture, or rarely tumor, resulting in kidney function loss. Herein, we describe the case of a 36-year-old female who presented with left loin pain, left lower limb pain, and dysuria. On contrast-enhanced computed tomography (CECT), multiple abscesses and an obstructive staghorn calculus were depicted in the left kidney with the classical appearance of "Bear Paw Sign." An abscess with calculi was also present within the left psoas muscle. Though psoas muscle abscess in association with XGP was described, a ureteric fistula and calculi within the psoas muscle have not yet been reported in the literature. Left nephrostomy was performed, which came out to be positive for E. coli on culture. The patient underwent left nephrectomy, and the histopathological report of the surgical specimen confirmed XGP.

Resolution of the more anteriorly positioned psoas muscle following correction of spinal sagittal alignment from spondylolisthesis: case report.

Several studies have described the radiographic, histological, and morphological changes to the paraspinal muscle in patients with chronic low-back pain due to degenerative diseases of the spine. Gross anatomical illustrations have shown that the psoas muscle lies lateral to the L4-5 vertebrae and subsequently thins and dissociates from the vertebral body at L5-S1 in a ventrolateral course. A "rising psoas" may influence the location of the lumbar plexus and result in transient neurological injury on lateral approach to the spine. It is postulated that axial back pain may be exacerbated by anatomical changes of paraspinal musculature as a direct result of degenerative spine conditions. To their knowledge, the authors present the first reported case of a more anteriorly positioned psoas muscle and its resolution following correction of spondylolisthesis in a 62-year-old woman. This case highlights the dynamic nature of degenerative spinal disorders and illustrates that psoas muscle position can be affected by sagittal balance. Normal anatomical positioning can be restored following correction of spinal alignment.

Internal Snapping Hip Syndrome: Incidence of Multiple-Tendon Existence and Outcome After Endoscopic Transcapsular Release.

PURPOSE: To report the frequency of presentation of bifid or multiple iliopsoas tendons in patients who underwent endoscopic release for internal snapping hip syndrome (ISHS) and to compare both groups. METHODS: A consecutive series of patients with ISHS were treated with endoscopic transcapsular release of the iliopsoas tendon at the central compartment and prospectively followed up. The inclusion criteria were patients with a diagnosis of ISHS with failure of conservative treatment. During the procedure, the presence of a bifid tendon was intentionally looked for. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were evaluated preoperatively and at last follow-up. Four patients presented with a bifid tendon and one patient had 3 tendons. At a minimum of 12 months' follow-up, the presence of snapping recurrence was evaluated and the WOMAC scores were compared between both groups. RESULTS: Among 279 hip arthroscopies, 28 patients underwent central transcapsular iliopsoas tendon release. The mean age was 29.25 years (range, 16 to 65 years; 6 left and 22 right hips). Group 1 included 5 patients with multiple tendons; the remaining patients formed group 2 (n = 23). None of the patients presented with ISHS recurrence. The mean WOMAC score in group 1 was 39 points (95% confidence interval [CI], 26.2 to 55.4 points) preoperatively and 73.6 points (95% CI, 68.4 to 79.6 points) at last follow-up. In group 2 the mean WOMAC score was 47.21 points (95% CI, 44.4 to 58.2 points) preoperatively and 77.91 points (95% CI, 67.8 to 83.4 points) at last follow-up. We identified a bifid tendon retrospectively on magnetic resonance arthrograms in 3 of the 5 cases that were found to have multiple tendons during surgery. None of these were recognized before the procedures. CONCLUSIONS: In this series the surgeon intentionally looked for multiple tendons, which were found in 17.85% of the cases. Clinical results in patients with single- and multiple-tendon snapping seem to be similarly adequate. However, the possibility of a type II error should be considered given the small number of patients. LEVEL OF EVIDENCE: Level IV.

Absceso de psoas en pediatría: a propósito de un caso / Psoas abscess in children: report of a case

Paciente de 14 años, con dolor abdominal en la fosa ilíaca izquierda, al que se le diagnosticó hematoma del psoas, con sospecha de sobreinfección. Se describe esta patología, y aspectos de su tratamiento.(AU)

Absceso de psoas en pediatría: a propósito de un caso / Psoas abscess in children: report of a case

Paciente de 14 años, con dolor abdominal en la fosa ilíaca izquierda, al que se le diagnosticó hematoma del psoas, con sospecha de sobreinfección. Se describe esta patología, y aspectos de su tratamiento.(AU)

Absceso de psoas en pediatría: a propósito de un caso / Psoas abscess in children: report of a case

Paciente de 14 años, con dolor abdominal en la fosa ilíaca izquierda, al que se le diagnosticó hematoma del psoas, con sospecha de sobreinfección. Se describe esta patología, y aspectos de su tratamiento.

Lumbarized sacrum as a relative contraindication for lateral transpsoas interbody fusion at L5-6.

STUDY DESIGN: Retrospective review. OBJECTIVE: To determine if lumbarized sacra at the L5-6 level (functional L4-5) are a contraindication to a lateral transpsoas approach. SUMMARY OF BACKGROUND DATA: Transitional vertebrae at the lumbosacral junction present mechanical and morphologic changes, though these changes have not been characterized with respect to the feasibility of a lateral transpsoas approach. METHODS: Three hundred fifty-one patients were scheduled for lumbar interbody fusion using a mini-open lateral transpsoas approach (XLIF) at L4-5 from 2004 to 2008 at a single institution. In patients with 6 lumbar vertebrae, accessibility, based on neuromonitoring, of the L5-6 level (functional L4-5) was reviewed. Qualitative assessments using axial magnetic resonance imaging (MRI) were performed and compared with a sample of patients with normal anatomy treated at L4-5. RESULTS: Of the 351 patients scheduled for treatment at L4-5, 10 (2.8%) were determined to have 6 lumbar vertebrae with the symptomatic level at L5-6. Of those 10, 2 (20%) could be treated using a lateral transpsoas approach, and 8 (80%) were converted to another approach after a corridor through the psoas muscle was not found, based on neuromonitoring feedback. Review of axial MRI showed a teardrop-shaped psoas detached from the lateral border of the disc space in patients with transitional anatomy unapproachable at L5-6, resemblant of L5-S1 in normal anatomy. In the 2 patients who could be safely approached, the psoas anatomy at L5-6 was similar to a normal L4-5 level, with a domed/helmet shape, attached laterally to the disc space. CONCLUSIONS: Treating the L5-6 level using a lateral transpsoas approach in individuals with lumbarized sacra can be challenging due to anatomy more similar to the L5-S1 level in normal patients. Preoperative planning using axial MRI and intraoperative adherence to advanced neuromonitoring can aid in identifying and avoiding injury in these rare patients.

[Congenital hypoplasia of the lower portion of the left psoas muscle]. / Prirodena hipoplazija donjeg dijela lijevoga m. psoasa.

We are presenting a case of a 58-year-old-male patient with a congenital hypoplasia of the lower portion of his left psoas muscle. This rare anomaly, which should be differentiated from other pathological conditions (destructive processes, tumors, metastases, inactivate atrophy), was discovered during the MRI examination of his lumbosacral (LS) spine which the patient underwent due to deterioration of chronic low back pain. His right psoas muscle was hypertrophic. CT examination of his abdomen has shown the identical finding. The MRI examination of his LS spine has shown the intensive and extensive degenerative changes. Besides the hypoplasia of the lower portion of his left psoas muscle, the radiological examinations of the LS spine (MRI) and abdomen (CT) have not shown any other congenital anomalies. Taking into consideration the patient history, the clinical finding, the results of the radiological and other examinations (EMNG) as well as the well known facts about psoas muscle anatomy and function (a stabilizer of the lumbar spine, pelvis and hip; the hip and trunk flexor; the lateral trunk flexor), in this case report, we analysed the clinical manifestations (lateral deviation of lumbar spine; pelvic asymmetry--elvic torsion; increased hip extension on the side of the hypoplastic psoas muscle) and also the late consequences of the unilateral hypoplasia of the psoas muscle (unilateral hypoplasia of the psoas muscle--the overloading of the LS spine and the other psoas muscle--the chronic low back pain--the compensatory hypertrophy of the other psoas muscle-->the intensive and extensive degenerative changes of the LS spine).

Bilateral iliopsoas muscle contracture and spinous process impingement in a German Shepherd dog.

OBJECTIVE: To report diagnosis and treatment of bilateral iliopsoas muscle contracture in a dog with spinous process impingement. STUDY DESIGN: Case report. ANIMALS: German Shepherd dog. METHODS: A dog with chronic progressive lameness, flexion contracture of the coxofemoral joints, severe pain, and decreased femoral reflexes had severe spondylosis bridging the vertebral bodies from L1 to L4 and enlarged dorsal spinous processes from T8 to L6 with impingement and bony proliferation. Ultrasonographic and magnetic resonance imaging (MRI) findings were consistent with fibrosis, mineralization, and atrophy of the iliopsoas muscles bilaterally which was treated by staged tenectomy of the insertions of the iliopsoas muscles. RESULTS: Because of severe perivascular fibrosis, the femoral vessels required ligation. Bilateral iliopsoas muscle tenectomy improved gait and provided pain relief. Histologic findings were consistent with fibrotic myopathy. CONCLUSIONS: Slow progression of severe clinical signs observed bilaterally in this dog differs from previous reports of iliopsoas myopathy. Findings were similar to the fibrotic myopathy of the gracilis or semitendinosus muscles described in dogs. CLINICAL RELEVANCE: Iliopsoas muscle abnormalities should be considered in dogs with limited hip extension and pain. MRI is useful for diagnosing muscle fibrosis. Iliopsoas tenectomy may improve clinical function in dogs with fibrotic myopathy.

The psoas quartus muscle.

We report an unusual finding in an adult male cadaver. During the routine dissection of the posterior abdominal wall as part of an anatomy course at our institution, an anomalous muscle was noted. This muscle originated from the transverse process of the left L3 vertebrae and the medial aspect of the quadratus lumborum. We believe this muscle to represent a variety of the psoas quartus that, to our knowledge, has only been described once before in the extant medical literature. The presence of a psoas quartus muscle may contribute to femoral nerve compression. The clinician may wish to consider this rare muscular anomaly in patients with symptoms of femoral nerve compression in which no other clear etiology is found. Furthermore, clinicians who image the posterior abdominal wall should be aware of this potential anomaly when interpreting the anatomy of this region.

Bilateral variations of the psoas major and the iliacus muscles and presence of an undescribed variant muscle--accessory iliopsoas muscle.

Inspite of the detailed description of the iliopsoas muscle complex, interesting variations of its main parts--the psoas major and the iliacus muscles can still be encountered. These variations may clarify some aspects of the embryological development of the iliopsoas and have certain clinical importance because of the frequent co-existence with an unusual femoral nerve by its formation and course. We present in our report a case of bilateral variations of the psoas major and the iliacus muscles combined with variations of the left and the right femoral nerves, which were found during the anatomical dissection of a female human cadaver. The most remarkable finding was noted on the left side, where an undescribed variant muscle accessory iliopsoas, was observed. It was the only finding of such a muscle among 108 human cadavers examined over a period of 22 years. The accessory iliopsoas was formed by the connection of two accessory muscles--accessory psoas major and accessory iliacus. The clinical significance of the described variant muscles and their importance as an additional factor in the femoral neuropathy are also a matter of discussion in our report.

Unilateral "vanishing psoas": an anatomic variant.

We report five patients found to have obvious asymmetry of the psoas muscles on abdominal computed tomography (CT) examination. In all five patients, the upper portion of the psoas muscle was normal, but the lower portion was significantly reduced in size. In no patient was there neurological or other disease that might explain this finding. No patient exhibited signs or symptoms secondary to psoas asymmetry. Asymmetry of the psoas musculature is apparently a benign anatomical variant that may be recognized on CT examination and must be differentiated from pathological conditions.