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  • Title: The sore psoas: a difficult diagnosis in childhood.
    Author: Smith S, Lenarz L, Mollitt DL, Golladay ES.
    Journal: J Pediatr Surg; 1982 Dec; 17(6):975-8. PubMed ID: 7161686.
    Abstract:
    Nontuberculous psoas abscess is an unusual disease of childhood. The symptoms closely mimic those of other disorders and delay of treatment is commonplace. Eight children (age range 1.5-12 yr) have been treated for psoas abscess. Each presented with a history of fever (38-40 degrees C) and pain. The pain was localized to the hip (3-right, 4-left) and aggravated by ambulation in 7 cases. In 6 children, there was associated lower abdominal tenderness and flexion of the involved hip at rest with resistance to extension. Only 1 child was correctly suspected of having a psoas abscess. Delay in appropriate therapy averaged 5 days (range 1-20 days). Five children underwent joint aspiration and an additional 3 underwent abdominal exploration prior to diagnosis. Surgical drainage was subsequently performed in each case. A retroperitoneal approach, either flank or inguinal, was employed. Staphylococcus aureus was isolated from all cultures. Primary psoas abscess is seldom included in the differential diagnosis of septic lower abdominal and/or lower extremity pain. It should, however, be considered, particularly in the child with classic findings of psoas irritation.
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