Current Concepts Review   |    
Primary Pyomyositis
J. Bickels, MD; L. Ben-Sira, MD; A. Kessler, MD; S. Wientroub, MD
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Investigation performed at the Departments of Pediatric Orthopaedics and Radiology, Dana Children's Hospital, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

J. Bickels, MD
L. Ben-Sira, MD
A. Kessler, MD
S. Wientroub, MD
Departments of Pediatric Orthopaedics (J.B. and S.W.) and Radiology (L.B.-S. and A.K.), Dana Children's Hospital, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, Tel-Aviv 64239, Israel. E-mail address for S. Wientroub: pedorth@tasmc.health.gov.il

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

J Bone Joint Surg Am, 2002 Dec 01;84(12):2277-2286
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• Primary pyomyositis is a rare, subacute, primary muscle infection that is probably the result of a transient bacteremia in most patients.
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    Shlomo Wientroub, MD
    Posted on March 31, 2010
    Drs. Wientroub and Bickels respond to Dr. Starr
    Dana Children's Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel

    Thank you for your letter from March 12, 2010. Our experience with percutaneous aspiration and drainage of retroperitoneal abscesses is somewhat different: over the last 5 years we have performed approximately 30 CT- and ultrasound-guided aspirations of psoas abscesses, for none of which we had to operate subsequently. We were privileged to write the Current Concepts Review on primary pyomyositis because of our experience in the management of this disease. However, the manuscript does not reflect our own treatment philosophy or conclusion of our experience but a methodological summary of the published data in the English literature until 2002, the year in which the manuscript was published. Because 8 years have passed since the original publication, it is possible that an updated review of pyomyositis will be concluded differently.

    Adam J. Starr, MD
    Posted on March 12, 2010
    Percutaneous Drainage Often Fails
    UT Southwestern Medical Center, Dallas, Texas

    To the Editor:

    Bickels et al. (1) wrote, "Drainage can now be accomplished percutaneously under ultrasonographic or computerized tomographic guidance, and operative intervention is used only when complete drainage cannot be achieved percutaneously or when such treatment is not available". My experience has been that percutaneous drainage often does not work, but belief in its effectiveness persists among my general surgery and radiology colleagues. Spurred on by a recent case of psoas abscess - a case in which the use of percutaneous drainage failed - I have been searching the literature, and the reports of the effectiveness of percutaneous drainage are mixed, at best. For example, Tabrizian et al., in a recent article (2), reported that percutaneous drainage was successful in only 40% of cases. Direct open surgical drainage was successful in every case in which it was employed.

    I wonder if the authors have encountered any failures of percutaneous drainage since their article was published?

    The author did not receive any outside funding or grants in support of his research for or preparation of this work. Neither he nor a member of his immediate family received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.


    1. Bickels J, Ben-Sira L, Kessler A, Wientroub S. Primary pyomyositis. J Bone Joint Surg Am. 2002;84:2277-86.

    2. Tabrizian P, Nguyen SQ, Greenstein A, Rajhbeharrysingh U, Divino CM. Management and treatment of iliopsoas abscess. Arch Surg. 2009;144:946-9.

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