Shields D W, Robinson Patrick G
Department of Trauma and Orthopaedics, Royal Victoria Infirmary, Newcastle-Upon-Tyne, Tyne and Wear, UK.
BMJ Case Rep. 2012 Dec 20;2012:bcr2012007419. doi: 10.1136/bcr-2012-007419.
A 35-year-old woman of Indian origin presented with a 5-month history of lower back pain, radiating down the back of her right leg in distribution of the sciatic nerve. Referral was made to the spinal clinic querying sciatica, but a deterioration in her symptoms developed, and the patient presented to the Accident and Emergency department. She was significantly tender at right sacroiliac joint and had positive psoas sign. The MRI scan showed a large iliopsoas abscess causing bony destruction, and extended culture was positive for mycobacterium tuberculosis. The patient was initially diagnosed with sciatica yet had a positive psoas sign and a painful sacrum. It is important that primary physicians are aware of the relations the iliopsoas muscle and the potential effect an abscess can have here. A sinister underlying cause of a patient's sciatic distribution of pain should be excluded before accepting a diagnosis of mechanical back pain.
一名35岁的印度裔女性，有5个月的下背部疼痛病史，疼痛沿坐骨神经分布向下放射至右腿后侧。转诊至脊柱诊所，怀疑为坐骨神经痛，但她的症状恶化，随后患者前往急诊部就诊。她的右骶髂关节有明显压痛，腰大肌征阳性。MRI扫描显示一个巨大的髂腰肌脓肿，导致骨质破坏，扩大培养结果显示结核分枝杆菌阳性。该患者最初被诊断为坐骨神经痛，但腰大肌征阳性且骶骨疼痛。基层医生必须了解髂腰肌的关系以及脓肿在此处可能产生的影响。在接受机械性背痛的诊断之前，应排除导致患者坐骨神经分布区疼痛的潜在严重病因。
