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To evaluate midterm results of percutaneous drainage (PD) with image guidance in 21 patients with tuberculous iliopsoas abscesses with or without spondylodiskitis.Computed tomography (CT)-guided PD was performed in 21 patients with 26 tuberculous iliopsoas abscesses. Nineteen patients had bone involvement of two or more vertebrae. Eleven patients with spondylodiskitis had intradiskal abscesses. Five patients had bilateral psoas abscesses. Easily and safely accessible well-circumscribed abscesses larger than 3 cm were selected for PD. Catheters were inserted into the abscess cavities with Seldinger technique in all cases. In conjunction with PD, all patients had antituberculous drug therapy and underwent clinical and imaging follow-up for at least 1 year.Percutaneous catheter placement was successful in all cases without procedural complications. On the basis of CT findings, complete evacuation of all abscesses was achieved initially. During follow-up, six (29%) of 21 patients had recurrences within 1 and 3 months after catheter removal. A total of 37 catheters were used; eight of the 37 catheters were inserted due to recurrences. Four patients needed two PD procedures, and two patients needed three due to recurrences. Four catheters were changed because of obstruction or dislocation. Drainage duration ranged from 5 to 36 days (mean, 14.9 days). The follow-up period was 12-52 months (mean, 24 months). None of the patients, including those with recurrence, required surgical drainage and débridement due to insufficient PD.Image-guided PD in conjunction with antituberculous drug therapy is an effective and safe procedure in the treatment of tuberculous iliopsoas abscesses with or without spondylodiskitis.

PURPOSE: To determine the value of ultrasound (US) in the diagnosis of snapping iliopsoas tendon. MATERIALS AND METHODS: In three patients, dynamic US of the hip was performed as the flexed, abducted, and externally rotated hip was extended. The contralateral hip was also evaluated. Hip arthrography was performed in all three patients, magnetic resonance imaging in two, and iliopsoas bursography in two, which was successful in only one case. One patient underwent surgical release of the iliopsoas tendon. RESULTS: At US, an abnormal jerk of the iliopsoas tendon during hip motion was correlated with the painful audible snap. The motion of the contralateral iliopsoas tendon was smooth. No intraarticular abnormality was found in two patients, and an associated labral tear was suspected at arthrography in the third patient. The patient who underwent surgical release of the iliopsoas tendon had great improvement. CONCLUSION: US is a useful dynamic noninvasive technique for the diagnosis of snapping iliopsoas te...

Nineteen patients with evidence of psoas and iliopsoas abnormalities on computed tomographic (CT) scans (12 with metastases, three with lymphoma, two with hematoma, and two with abscess) were examined with magnetic resonance (MR) imaging. The abnormal psoas could be identified on both T1- and T2-weighted spin-echo images, although T2-weighted sequences provided better contrast. The psoas muscle can be affected by one of three mechanisms: total replacement, lateral displacement, or medial displacement. In four patients in whom the CT study showed apparent enlargement of a psoas muscle, subsequent MR imaging examinations demonstrated that the psoas muscle was compressed and displaced laterally by a paraspinal mass. MR images provided better contrast between the normal and abnormal psoas than CT scans in nine cases; MR images were inferior to CT scans in two cases because calcifications (one case) and air bubbles within an abscess (one case) were not detectable.

Fifty-four hemophiliac patients underwent a total of 94 studies using computed tomography (CT), ultrasound, or both. Not only common bleeding sites such as the iliopsoas muscles but also several unusual sites were encountered: these included the iliac bone, bowel wall, mesentery, rectus abdominis muscle, retroperitoneum, bladder wall, and scrotum. Both modalities gave comparable results, and each was helpful in (a) establishing the diagnosis, (b) evaluating the extent of bleeding and its effect on adjacent organs, and (c) demonstrating regression after treatment.

Fifteen patients with Crohn disease underwent percutaneous catheter drainage of related abdominal abscesses. The abscesses were located in the right lower quadrant (five patients); in the quadratus lumborum and/or iliopsoas muscles (four patients); in the left paracolic gutter (two patients); and in the right gluteal muscles, the liver, the left subphrenic space, and the pelvis (one patient each). All abscesses were evacuated successfully (n = 15 of 15), and no patient required surgery for abscess drainage. Existing fistulas closed in four of seven patients; the other three patients underwent surgery for excision of diseased bowel and enteric fistulas. No patient developed an enterocutaneous fistula as a result of catheter drainage. Percutaneous abscess drainage is effective for abscesses related to Crohn disease and should be regarded as the procedure of choice. An operation for the abscess can be avoided, and early results suggest that bowel surgery may be obviated in selected patients.

A case of pear-shaped bladder resembling pelvic lipomatosis was shown to be caused by large iliacus and psoas muscles.

Nine cases of teardrop bladder (TDB) seen at excretory urography are presented. In some of these patients, the iliopsoas muscles were at the upper limit of normal in size, and additional evaluation of the perivesical structures with computed tomography (CT) was necessary. CT demonstrated only hypertrophied muscles with or without perivesical fat. The psoas muscles and pelvic width were measured in 8 patients and compared with the measurements of a control group of males without TDB. Patients with TDB had large iliopsoas muscles and narrow pelves compared with the control group. The psoas muscle width/pelvic width ratio was significantly greater (p less than 0.0005) in patients with TDB than in the control group, with values of 1.04 +/- 0.05 and 0.82 +/- 0.09, respectively. It is concluded that TDB is a not uncommon normal variant in black males. Both iliopsoas muscle hypertrophy and a narrow pelvis are factors that predispose a patient to TDB.

Magnetic resonance (MR) imaging was performed on 15 healthy subjects to define the appearance of the iliopsoas muscle and on 15 patients with iliopsoas disease. Seven patients had tumorous involvement of the muscles, five had inflammatory disease, one had retroperitoneal hemorrhage, one had iliopsoas bursitis, and one had bilateral hypertrophy. MR imaging permitted delineation of the muscles and depiction of the disease condition. Transverse MR images alone almost always provided the necessary data to determine the origin and extent of disease. Sagittal images were occasionally useful in defining the extension of disease into the spine. T1-weighted images provided optimal contrast between the muscles and adjacent tissues, while T2-weighted images were more useful for depicting disease within the muscles themselves.

The intent of this report is to present the rather striking appearance of the pelvis after subjection to the Sharrard or Mustard operations for hip stabilization. This appearance may be quite misleading to radiologists who are not aware of these procedures. The Sharrard operation as performed by Dr. John Sharrard of the Children's Hospital, Sheffield, England, has been described in detail by Dr. J. H. Allan (1). It is being performed at several centers in the United States, and radiologists may expect to be confronted with this iatrogenic change. The Mustard operation is, however, more widely recognized (2). The operation consists of an iliopsoas transfer used to provide hip stability for patients with hip abductor weakness and is most commonly performed in myelomeningocele. Following an adductor tenotomy, the iliopsoas muscle is transplanted from the lesser trochanter of the femur, posteriorly, through a hole in the wing of the ilium, and attached to the greater trochanter of the femur. The Mustard opera...

The snapping tendon syndrome may be caused by abnormalities of the fascia lata, gluteus maximus muscle, or less commonly, the iliopsoas tendon. One case is reported in which fluoroscopic monitoring after computed tomography-guided injection of contrast material confirmed the diagnosis of snapping iliopsoas tendon syndrome.

It has been observed that, in pregnant women, intravenous pyelography is more successful than in non-pregnant women and this has proved true in cases in which the two iodine compounds, uroselectan and abrodil, have been used. The success of this method of visualization in pregnant women has been explained by the fact that the fetus makes pressure either on the iliopsoas muscle or on the ureters as they cross the brim of the pelvis, or just before they enter the bladder. This observation incited us to try to imitate fetal pressure. To produce the necessary effect we have to apply pressure either on the bladder or the ureters, as the fetus applies its pressure. In the German literature on this subject, we read that pressure is applied over the abdomen to compress the ureters. This, obviously, is difficult and at times impossible of accomplishment, especially in obese individuals. When we realized the faults of the abdominal pressure method, we began to work out a method of imitating fetal pressure in the mo...