A 49-year-old Vietnamese man is diagnosed with tuberculosis. On physical examination, large flocculent masses are noted over the lateral lumbar back, and a similar mass is located in the ipsilateral groin. This pattern of involvement strongly suggests an abscess tracking along the
A.
Adductor longus
B.
Gluteus maximus
C.
Gluteus minimus
D.
Piriformis
E.
Psoas major
The correct answer is E. This is the classic presentation of a psoas abscess. This clinical entity was formerly a
fairly common complication of vertebral tuberculosis, but is now rare in clinical practice in this country. The
psoas muscle is covered by a fibrous sheath known as the psoas fascia. This sheath is open superiorly,
permitting an infection involving the soft tissues around the spine to enter the sheath, then track down to the
groin.
The adductor longus (choice A) is a muscle of the anterior thigh, and is not related to the lumbar portion of the back.
The gluteus maximus (choice B) gluteus minimus (choice C) and piriformis (choice D) are muscles of the
buttock with no relationship to the groin.