Over a 5-year period, 56
psoas abscesses occurring in 51 patients were managed by image-guided percutaneous drainage, either by needle aspiration (n = 10) or by
catheter drainage (n = 46) in conjunction with medical
therapy. Twenty-seven patients had tuberculous
abscesses (bilateral in five) while 24 patients had pyogenic
abscesses. Percutaneous treatment was successful in 16 of the 24 patients (66.7%) with pyogenic
abscesses. The reasons for failure were co-existent bowel lesions, phlegmonous involvement of muscle without liquefaction, multiloculated
abscess cavity and thick tenacious
pus not amenable to percutaneous drainage. Surgery was required in seven patients, either for failed percutaneous drainage or for the management of co-existent disease. Percutaneous drainage was initially successful in all 27 patients of tuberculous
psoas abscesses. However, eight patients presented with recurrence requiring repeat intervention. The average duration of
catheter drainage was longer in patients with tuberculous
abscess (11 days) than in patients with pyogenic
abscess (6 days). Percutaneous drainage under image guidance provides an effective and safe alternative to more invasive surgical drainage in most patients with
psoas abscesses.