Beyond the psoas: iliopsoas abscess with thigh extension successfully managed by percutaneous approach

Iliopsoas abscess is an uncommon but potentially life-threatening condition. Distal extension into the thigh is extremely rare and usually requires surgery. We report the case of a 65-year-old woman presenting with fever, back pain, and impaired hip mobility. Contrast-enhanced computed tomography revealed a multiloculated iliopsoas abscess extending into the thigh adductor compartment. Under combined ultrasound and fluoroscopic guidance, multi-access percutaneous drainage was performed using one retroperitoneal and two femoral catheters, yielding purulent material positive for <i>Staphylococcus aureus</i>. Targeted antibiotic therapy and serial catheter lavages led to rapid recovery. Drains were removed after 14 days, and the patient remained symptom-free at 3-month follow-up. This case demonstrates that even complex iliopsoas abscesses with thigh extension can be successfully treated with a tailored image-guided percutaneous approach, providing a safe and effective alternative to open surgery in selected cases.