A Rare Cause of Flank Mass: Psoas Abscess due to Extensive Primary Thoracolumbar Tuberculous Spondylodiskitis
H.T. Sanala,
M. Kocaoglua,
A. Sehirlioglub and
N. Bulakbasia
a Department of Radiology, Gulhane Military Medical School, 06018, Etlik, Ankara, Turkey
b Department of Orthopedic Surgery and Traumatology, Gulhane Military Medical School, 06018, Etlik, Ankara, Turkey
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Fig 1. Transverse abdominal sonogram, obtained inferior to the right kidney, shows a cystic mass with fine internal echoes involving the right psoas muscle (arrows).
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Fig 2. Abdominal MR imaging.
A, Fat-saturated T2-weighted (TR/TE, 2100/90) axial MR image obtained through the iliac fossa shows a multilobulated cystic lesion (star) involving almost the whole of the right psoas muscle, extending to the right flank over the sacroiliac notch (arrowhead).
B, Noncontrast T1-weighted (TR/TE, 614/16) and (C) contrast-enhanced T1-weighted axial images. The cystic lesion is low in signal intensity and shows rim enhancement after contrast media injection.
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Fig 3. Coronal reconstructed noncontrast multidetector CT image of the chest demonstrates an extensive paravertebral soft-tissue mass and bone destruction at the adjacent endplates of the thoracic sixth and seventh vertebrae.
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Fig 4. Spinal MR imaging.
A, Coronal T2-weighted (TR/TE, 2500/120) thoracolumbar image shows widespread paravertebral soft tissue (arrowheads) and enlarged right psoas muscle (star) displacing the right kidney. The abscess has almost completely replaced the psoas muscle, though a small portion of it can still be noticed between the abscess and vertebral colon. High-signal-intensity patchy areas on vertebral bodies are consistent with osteomyelitis.
B, T2-weighted and (C) contrast-enhanced T1-weighted (TR/TE, 580/14) sagittal scans. Enhancing prevertebral soft-tissue lesions (arrowheads) and osteomyelitis with high signal intensity on the T2-weighted scan, with patchy contrast enhancement on the T1-weighted scan, are seen. Subcutaneous flank mass reveals high T2 and low T1 signal intensity with rim enhancement (curved arrow). Midthoracic disk space narrowing suggesting diskitis and adjacent endplate bony destruction are also evident.
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