From the Research
Yes, a right-sided psoas abscess communicating with the L2/L3 disc in an 81-year-old female patient can be drained. The recommended approach would be CT-guided percutaneous drainage as the first-line treatment, which is less invasive than open surgical drainage and particularly appropriate for elderly patients, as supported by the most recent and highest quality study 1. This procedure involves inserting a drainage catheter under CT guidance to evacuate the purulent material. Prior to drainage, blood cultures should be obtained, and empiric antibiotic therapy should be initiated, typically with broad-spectrum coverage such as vancomycin 15-20 mg/kg IV every 12 hours plus piperacillin-tazobactam 3.375g IV every 6 hours (dose adjusted for renal function). The catheter would remain in place until drainage becomes minimal, usually 3-7 days. The connection to the L2/L3 disc suggests this may be a secondary psoas abscess from vertebral osteomyelitis or discitis, which requires a longer antibiotic course (typically 6 weeks) based on culture results. For this elderly patient, a multidisciplinary approach involving infectious disease specialists, interventional radiology, and possibly spine surgeons is essential to manage both the abscess and the underlying disc infection while considering her age-related physiological changes and potential comorbidities. Some studies suggest alternative approaches such as laparoscopic drainage 2 or retroperitoneoscopic drainage 3, but CT-guided percutaneous drainage remains the most commonly recommended and least invasive first-line treatment. It's also worth noting that a multimodal approach using MRI for diagnosis and CT for drainage guidance, as well as the use of Cone Beam CT (CBCT)-MRI fusion techniques with navigation systems, can enhance treatment precision and outcomes, particularly in complex cases 1.