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Thornhill BA, Thompson L. MR Imaging of the Hip: Infectious and Inflammatory Conditions. Magn Reson Imaging Clin N Am 2025; 33:167-181. [PMID: 39515956 DOI: 10.1016/j.mric.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2024]
Abstract
MR imaging is a useful tool in establishing the diagnosis of inflammation and/or infection in the hip joint and adjacent tissues, and in determining the extent of disease. In conjunction with clinical factors, MR imaging findings can help to narrow the differential diagnosis in individual cases and can guide decisions regarding biopsies, aspirations, or additional imaging.
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Affiliation(s)
- Beverly A Thornhill
- Department of Radiology and Orthopaedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA.
| | - Lee Thompson
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
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2
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Dundar A, Young JR, Wenger DE, Inwards CY, Broski SM. Unusual manifestations of diffuse-type tenosynovial giant cell tumor in two patients: importance of radiologic-pathologic correlation. Skeletal Radiol 2020; 49:483-489. [PMID: 31656976 DOI: 10.1007/s00256-019-03325-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/24/2019] [Accepted: 09/30/2019] [Indexed: 02/02/2023]
Abstract
Diffuse-type tenosynovial giant cell tumor (TSGCT) is a rare, locally aggressive neoplasm. It most commonly occurs in the knee, followed by the hip, and has distinctive imaging features, including mass-like foci of low T2 signal intensity, "blooming" on gradient-echo MRI, and pronounced uptake on FDG PET/CT. Histologically, TSGCT demonstrates a neoplastic population of mononuclear cells admixed with hemosiderin-laden macrophages, foamy histiocytes, inflammatory cells, and osteoclast-like giant cells. In cases where diffuse-type TSGCT presents in an uncommon location or with atypical features, the imaging diagnosis may be challenging. Furthermore, because of its polymorphous appearance, it may be mistaken microscopically for other neoplastic and non-neoplastic histiocytic lesions. Herein, we present two cases of diffuse-type TSGCT presenting as large masses, and underscore the importance of radiologic-pathologic correlation for accurate diagnosis.
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Affiliation(s)
- Ayca Dundar
- Department of Radiology, Mayo Clinic, Charlton Building North, 1st Floor, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jason R Young
- Department of Radiology, Mayo Clinic, Charlton Building North, 1st Floor, 200 First Street SW, Rochester, MN, 55905, USA
| | - Doris E Wenger
- Department of Radiology, Mayo Clinic, Charlton Building North, 1st Floor, 200 First Street SW, Rochester, MN, 55905, USA
| | - Carrie Y Inwards
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Stephen M Broski
- Department of Radiology, Mayo Clinic, Charlton Building North, 1st Floor, 200 First Street SW, Rochester, MN, 55905, USA.
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Wang J, Shao J, Qiu C, Chen Y, Liu B. Synovial cysts of the hip joint: a single-center experience. BMC Surg 2018; 18:113. [PMID: 30518347 PMCID: PMC6282245 DOI: 10.1186/s12893-018-0450-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 11/26/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Synovial cyst of the hip joint is a rare clinical condition in need of evidence-based guidelines for its diagnosis and management. Normally, synovial cyst of the hip joint requires no treatment, but when it intrudes into surrounding structures, various clinical symptoms appear. Because of its rarity, a symptomatic synovial cyst is often confounded with a tumor as a space-occupying lesion or with other diseases, depending on its various clinical presentations. Therefore, guidelines for the precise diagnosis and appropriate management for synovial cyst of the hip joint are required. METHODS We retrospectively studied 7 cases of symptomatic synovial cyst of the hip joint, some of which showed lower limb edema due to mass effect. We compared physical exam findings on presentation, imaging findings, and size and location of the cyst. RESULTS All cases were managed successfully with surgical excision. We found that, instead of the size of the cyst, the location of the cyst was an important contributor to venous compression. The recurrence rate was 0%, and some patients have significantly long follow-up of 2 years, 4 years, 6 years and 10 years, respectively. CONCLUSIONS For symptomatic synovial cyst of the hip joint, surgical excision can successfully resolve the symptoms without recurrence. This retrospective study discusses the clinical presentations, diagnostic approaches, and surgical treatment of symptomatic synovial cyst of the hip joint, hence shedding more light on the clinical management of this condition.
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Affiliation(s)
- Jingjing Wang
- Department of Vascular Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jiang Shao
- Department of Vascular Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Chenyang Qiu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yu Chen
- Department of Vascular Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Bao Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
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Angelini A, Zanotti G, Berizzi A, Staffa G, Piccinini E, Ruggieri P. Synovial cysts of the hip. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 88:483-490. [PMID: 29350664 PMCID: PMC6166169 DOI: 10.23750/abm.v88i4.6896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 11/13/2017] [Indexed: 12/20/2022]
Abstract
Background: Synovial cysts of the hip are relatively rare lesions comparing to other joints. Patients are usually asymptomatic, but in some cases symptoms such as pain and/or compression of vessels or nerve could be present. Purpose of the study was to define clinical features and optimal management of synovial cyst of the hip joint through an accurate review of the literature. Methods: We present three consecutive cases treated with three different therapeutic strategies: surgical excision, wait-and-see and needle aspiration. An accurate review of the literature has been performed to identify patients who had been treated for synovial cyst of the hip. Results: Due to the rarity of the disease, there are no significant data in literature supporting the gold standard of treatment. Treatment of the synovial cyst depends on their size, symptoms and comorbidities. Conclusions: Most of the Authors recommend surgical treatment for symptomatic synovial cysts and needle aspiration as an option treatment in asymptomatic patients without vessel or nerve compression. In patients that referred symptoms in correspondence with the hip joint, not strictly related with radiograph findings, a CT or MRI examinations should be performed to exclude possible differential diagnosis. (www.actabiomedica.it)
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Affiliation(s)
- Andrea Angelini
- Department of Orthopedics and Orthopedic Oncology, University of Padova, Italy.
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5
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Iliopsoas bursal extension of lipohemarthrosis: A novel imaging finding associated with hip fracture. Skeletal Radiol 2017; 46:253-257. [PMID: 27872955 DOI: 10.1007/s00256-016-2532-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 11/01/2016] [Accepted: 11/07/2016] [Indexed: 02/02/2023]
Abstract
Lipohemarthrosis is well known to be associated with intra-articular fractures throughout the body. Despite the relatively common occurrence of hip fracture and the frequency of communication between the hip joint and iliopsoas bursa, to the best of our knowledge, a fat-fluid level involving the iliopsoas bursa secondary to a hip fracture has not previously been reported. The following is a case report of a 48-year-old male who sustained an acute femoral neck fracture and was found to have distension of the iliopsoas bursa with a fat-fluid level resulting from extra-capsular extension of a lipohemarthrosis. The imaging findings, relevant anatomy, and potential importance of this finding for the detection of hip fracture are discussed.
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6
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Yukata K, Nakai S, Goto T, Ikeda Y, Shimaoka Y, Yamanaka I, Sairyo K, Hamawaki JI. Cystic lesion around the hip joint. World J Orthop 2015; 6:688-704. [PMID: 26495246 PMCID: PMC4610911 DOI: 10.5312/wjo.v6.i9.688] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 07/13/2015] [Accepted: 09/08/2015] [Indexed: 02/06/2023] Open
Abstract
This article presents a narrative review of cystic lesions around the hip and primarily consists of 5 sections: Radiological examination, prevalence, pathogenesis, symptoms, and treatment. Cystic lesions around the hip are usually asymptomatic but may be observed incidentally on imaging examinations, such as computed tomography and magnetic resonance imaging. Some cysts may enlarge because of various pathological factors, such as trauma, osteoarthritis, rheumatoid arthritis, or total hip arthroplasty (THA), and may become symptomatic because of compression of surrounding structures, including the femoral, obturator, or sciatic nerves, external iliac or common femoral artery, femoral or external iliac vein, sigmoid colon, cecum, small bowel, ureters, and bladder. Treatment for symptomatic cystic lesions around the hip joint includes rest, nonsteroidal anti-inflammatory drug administration, needle aspiration, and surgical excision. Furthermore, when these cysts are associated with osteoarthritis, rheumatoid arthritis, and THA, primary or revision THA surgery will be necessary concurrent with cyst excision. Knowledge of the characteristic clinical appearance of cystic masses around the hip will be useful for determining specific diagnoses and treatments.
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7
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Natsume K, Yamamoto K, Tanaka K, Hiraiwa T, Tanaka K. A Case of External Compression of Femoral Vein by the Enlarged Iliopsoas Bursa with Long Term Edema. Ann Vasc Dis 2015; 8:100-2. [PMID: 26131029 DOI: 10.3400/avd.cr.14-00124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 03/09/2015] [Indexed: 11/13/2022] Open
Abstract
The iliopsoas bursa is the largest bursa in the region of hip joint. It is unusual that these bursa become symptomatic. However the bursa can compress femoral vein, leading to lower extremity edema. A 58-year-old man was referred to our department for his unilateral leg edema which had been treated as deep vein thrombosis without any favorable response. Magnetic resonance angiography was performed, which demonstrated enlarged iliopsoas bursa compressing his femoral vein. Surgical removal of the bursa was performed. The postoperative course was uneventful, and the patient is free from symptoms with no evidence of recurrence.
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Affiliation(s)
- Kayoko Natsume
- Department of Cardiovascular Surgery, Hamamatsu Medical Center, Hamamatsu, Shizuoka, Japan
| | - Kiyohito Yamamoto
- Department of Cardiovascular Surgery, Hamamatsu Medical Center, Hamamatsu, Shizuoka, Japan
| | - Keizo Tanaka
- Department of Cardiovascular Surgery, Hamamatsu Medical Center, Hamamatsu, Shizuoka, Japan
| | - Takane Hiraiwa
- Department of Cardiovascular Surgery, Hamamatsu Medical Center, Hamamatsu, Shizuoka, Japan
| | - Kuniyoshi Tanaka
- Department of Cardiovascular Surgery, Hamamatsu Medical Center, Hamamatsu, Shizuoka, Japan
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8
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Iwata T, Nozawa S, Ohashi M, Sakai H, Shimizu K. Giant iliopectineal bursitis presenting as neuropathy and severe edema of the lower limb: case illustration and review of the literature. Clin Rheumatol 2013; 32:721-5. [PMID: 23478907 DOI: 10.1007/s10067-013-2223-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Revised: 02/02/2013] [Accepted: 02/27/2013] [Indexed: 12/19/2022]
Abstract
We report a 61-year-old woman with rheumatoid arthritis (RA: Steinblocker stage III, class 3) who developed severe swelling and neuropathy of the right lower limb caused by an iliopectineal bursa associated with destruction of the hip joint. Physical examination revealed an inguinal mass and groin pain. X-ray examination indicated destruction of the hip joint. Contrast-enhanced computed tomography showed the bursa connected with the hip joint and a markedly compressed external iliac vein among the inguinal ligament, pubis, and bursa. The patient underwent partial synovial resection and total hip arthroplasty for recovery of hip function, and this led to successful resolution of the symptoms and bursa. We present the characteristic images from this case and review all previously reported cases of RA iliopsoas bursitis causing leg swelling or neuropathy, and summarize the background. Since this lesion may cause various symptoms, clinical awareness that iliopsoas bursitis may present with unique clinical symptoms may aid correct diagnosis.
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Affiliation(s)
- Takahiro Iwata
- Department of Orthopaedic Surgery, Matsunami General Hospital, Gifu, Japan
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9
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Kawasaki M, Inoue H, Sabanai K, Sawai T, Sato K. Synovial cyst of the hip in a patient with rheumatoid arthritis. Mod Rheumatol 2012; 23:587-92. [PMID: 22729869 DOI: 10.1007/s10165-012-0697-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 06/01/2012] [Indexed: 12/21/2022]
Abstract
A 67-year-old woman with rheumatoid arthritis (RA; Steinblocker stage IV, class 4) who had RA onset at 34 years of age had anterior thigh pain, femoral neuropathy and lower abdominal pain. Physical examination showed multidirectional limit of motion, and radiographic examination showed destruction of the hip joint. MRI and arthrography indicated a cystic lesion that communicated with the hip joint. The rheumatoid synovial cyst was removed during total hip arthroplasty. The symptoms were relieved, and the mass was reduced in size.
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Affiliation(s)
- Makoto Kawasaki
- Department of Orthopaedics, Tohoku Rosai Hospital, 4-3-21 Dainohara, Aoba-ku, Sendai, Miyagi 981-8563, Japan.
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10
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Trout R. Iliopsoas Bursitis. Pain Manag 2011. [DOI: 10.1016/b978-1-4377-0721-2.00107-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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11
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Yoshioka T, Tachihara A, Koyama T, Iwakawa K, Sakane M, Nakamura H. Rapid destruction of the hip joint associated with enlarged iliopsoas bursa in a patient with refractory rheumatoid arthritis. J NIPPON MED SCH 2008; 75:233-8. [PMID: 18781048 DOI: 10.1272/jnms.75.233] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A case of refractory rheumatoid arthritis with a rapid destruction of the hip joint and an enlarged iliopsoas bursa is presented. Rapidly destructive coxarthrosis, chondrocalcinosis, suppurative arthritis, and pigmented villonodular synovitis were the differential diagnoses. Radiological examination showed that rheumatoid arthritis was most likely diagnosis. The patient was treated with total hip arthroplasty and etanercept, with good results.
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Affiliation(s)
- Taro Yoshioka
- Department of Joint Disease and Rheumatism, Nippon Medical School, Tokyo, Japan
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12
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Rossi FH, Araújo R, César EM. Compressão extrínseca de veia ilíaca externa e edema de membro inferior por cisto sinovial coxofemoral. J Vasc Bras 2007. [DOI: 10.1590/s1677-54492007000400013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A trombose venosa profunda (TVP) é uma freqüente causa de edema unilateral de membros inferiores. O cisto sinovial da articulação coxofemoral pode ser uma causa rara desse sintoma e deve ser considerado no diagnóstico diferencial. Apresentamos um caso clínico em que o eco-Doppler colorido revelou a presença de compressão extrínseca da veia ilíaca externa. A ressonância magnética demonstrou tratar-se de cisto sinovial como fator etiológico, confirmado pela ressecção cirúrgica.
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13
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Iliopsoas Bursitis. Pain Manag 2007. [DOI: 10.1016/b978-0-7216-0334-6.50102-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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14
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Matsumoto T, Juji T, Mori T. Enlarged psoas muscle and iliopsoas bursitis associated with a rapidly destructive hip in a patient with rheumatoid arthritis. Mod Rheumatol 2006; 16:52-4. [PMID: 16622726 DOI: 10.1007/s10165-005-0449-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2005] [Accepted: 12/06/2005] [Indexed: 10/25/2022]
Abstract
A 39-year-old man with rheumatoid arthritis developed femoral neuropathy secondary to iliopsoas bursitis. The adjacent hip joint was severely damaged. Magnetic resonance imaging showed enlargement and inflammation of the psoas muscle at the same side of iliopsoas bursitis. Iliopsoas bursitis and abnormal findings of the psoas muscle disappeared while the symptoms improved.
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Affiliation(s)
- Takumi Matsumoto
- Department of Orthopaedic Surgery, National Hospital Organization, Sagamihara National Hospital, 18-1 Sakuradai, Sagamihara 228-0815, Japan.
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Colasanti M, Sapienza P, Moroni E, Mosiello G, Postacchini F, di Marzo L. An unusual case of synovial cyst of the hip joint presenting as femoral vein compression and severe lower limb edema. Eur J Vasc Endovasc Surg 2006; 32:468-70. [PMID: 16861017 DOI: 10.1016/j.ejvs.2006.05.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2006] [Accepted: 05/16/2006] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Synovial cyst of the hip joint causing the compression of the femoral vein is a rare occurrence. We carefully reviewed the international literature collecting 26 additional cases. REPORT A case of a patient affected with synovial cyst of the hip joint causing the compression of the femoral vein and severe lower limb edema is presented. DISCUSSION The treatment of choice of synovial cyst compressing the femoral vein is surgical removal.
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Affiliation(s)
- M Colasanti
- Department of Surgery Pietro Valdoni, University of Rome La Sapienza, Rome, Italy
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16
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Affiliation(s)
- Catherine C Roberts
- Department of Radiology, Mayo Clinic College of Medicine, 13400 E. Shea Blvd., Scottsdale, AZ 85259, USA.
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17
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Sugiura M, Komiyama T, Akagi D, Miyata T, Shigematsu H. Compression of the Iliac Vein by a Synovial Cyst. Ann Vasc Surg 2004; 18:369-71. [PMID: 15354643 DOI: 10.1007/s10016-004-0025-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
While a synovial cyst of the hip is a rare cause of lower limb swelling, a differential diagnosis of deep vein thrombosis is needed. A case of lower limb swelling due to compression of the external iliac vein by a synovial cyst is presented with a review of the literature. Sagittal views and three-dimensional images of a CT scan were very useful for the diagnosis. This is the first review in English of vessel compression by a synovial cyst of the hip.
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Affiliation(s)
- Miki Sugiura
- Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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18
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Affiliation(s)
- R Allen Butler
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA
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19
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Yoon TR, Song EK, Chung JY, Park CH. Femoral neuropathy caused by enlarged iliopsoas bursa associated with osteonecrosis of femoral head--a case report. ACTA ORTHOPAEDICA SCANDINAVICA 2000; 71:322-4. [PMID: 10919308 DOI: 10.1080/000164700317411960] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- T R Yoon
- Department of Orthopedic Surgery, Chonnam University Hospital, Kwangju, Korea.
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20
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Dubois A, Ferru JM, Dubois A. [Periodic bursitis in the iliac psoas]. Rev Med Interne 1998; 19:522-3. [PMID: 9775207 DOI: 10.1016/s0248-8663(99)80014-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Iliopsoas bursitis is an unusual cause of hip pain. The condition may be due to athletic activity or may be secondary to a variety of inflammatory etiologies. An understanding of the anatomy and biomechanics of this structure is necessary to ensure prompt and appropriate radiologic diagnosis and clinical treatment. We report two cases of iliopsoas bursitis diagnosed with MRI and review the anatomy, pathophysiology, and treatment of this condition.
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Affiliation(s)
- D B Kozlov
- Department of Radiology, Northwestern University, Chicago, IL USA
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22
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Al-Khodairy AT, Gobelet C, Nançoz R, De Preux J. Iliopsoas bursitis and pseudogout of the knee mimicking L2-L3 radiculopathy: case report and review of the literature. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 1997; 6:336-41. [PMID: 9391806 PMCID: PMC3454611 DOI: 10.1007/bf01142682] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We report the case of a 74-year-old woman who presented with acute-onset right groin pain irradiating to the thigh anteriorly after having suffered for a few weeks from slight knee pain. As a CT scan showed multiple herniated intervertebral discs and spinal stenosis at the L3-L4 level, she was referred to a neurosurgical unit with the tentative diagnosis of L2-L3 radicular pain. Investigations (MR, myelography with CT scan) showed severe acquired lumbar canal stenosis. Decompression surgery was finally postponed because of the patient's serious cardiac medical history and she was referred to us for conservative treatment. She was found to have iliopsoas bursitis with chondrocalcinosis of the knee. Local steroid injections of the two sites abolished her symptoms. We draw attention to the possible pitfalls that the radiographic appearance and one of the multiple clinical presentations of this unrare pathology may represent. Whenever a patient comes walking with crutches, avoids putting weight on his or her leg, and radicular pain is suspected, we advise consideration of other extra-spinal causes for the pain.
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Affiliation(s)
- A T Al-Khodairy
- Department of Physical Medicine and Rehabilitation, Hôpital de Gravelone, Sion, Switzerland
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23
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Yang SS, Bronson MJ. Cystic enlargement of the iliopsoas bursa causing venous obstruction as a complication of total hip arthroplasty. A case report. J Arthroplasty 1993; 8:657-61. [PMID: 8301286 DOI: 10.1016/0883-5403(93)90015-v] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The authors report an unusual complication of total hip arthroplasty. A patient developed significant swelling and discomfort in the left lower extremity 4 1/2 years following a left total hip arthroplasty. Magnetic resonance imaging and venography demonstrated a large intrapelvic mass compressing the external iliac vein. An arthrogram revealed a cystic cavity consistent with an iliopsoas bursa in communication with the hip pseudocapsule. Two aspirations of the bursa led to resolution of the cystic enlargement and symptoms. An enlarged iliopsoas bursa should be considered in the differential diagnosis of hip pain or extremity swelling after total hip arthroplasty.
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Affiliation(s)
- S S Yang
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY 10021
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24
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Meaney JF, Cassar-Pullicino VN, Etherington R, Ritchie DA, McCall IW, Whitehouse GH. Ilio-psoas bursa enlargement. Clin Radiol 1992; 45:161-8. [PMID: 1555365 DOI: 10.1016/s0009-9260(05)80632-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The clinical and radiological features of 14 patients with ilio-psoas bursal enlargement associated with articular disease of the hip are presented. The condition primarily affects patients over the range of 50 years with pre-existing hip disease, usually of long duration. A clinical diagnosis before investigation was never made in our series as the symptoms were non-specific and varied, consisting of pain (40%), a palpable groin mass (40%) and lower limb swelling (28%). The diagnosis can be made pre-operatively and the extent along the path of the ilio-psoas accurately delineated. The bursal contents, although predominantly fluid in nature, do include a varying proportion of solid components. Ultrasound is the simplest, quickest and most cost effective means of demonstrating the hip effusion, the bursa, its contents and extent. Although the compressive effects are well seen sonographically, computed tomography (CT) and magnetic resonance imaging (MRI) provide a better appreciation of the regional anatomy and hip joint disease.
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Affiliation(s)
- J F Meaney
- Department of Diagnostic Imaging, Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry
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25
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26
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Manueddu CA, Hoogewoud HM, Balague F, Waldeburger M. Infective iliopsoas bursitis. A case report. INTERNATIONAL ORTHOPAEDICS 1991; 15:135-7. [PMID: 1917187 DOI: 10.1007/bf00179712] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We report a case of infective iliopsoas bursitis, and to our knowledge a similar case has not been described. The anatomical relation between the bursa and the hip, and related pathological conditions are reviewed. The contribution of CT-guided catheterisation is emphasised as it allows aspiration of fluid, injection of radio-opaque material and lavage.
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Affiliation(s)
- C A Manueddu
- Département de Chirurgie, Hôpital Cantonal Universitaire, Genève, Switzerland
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Savarese RP, Kaplan SM, Calligaro KD, DeLaurentis DA. Iliopectineal bursitis: An unusual cause of iliofemoral vein compression. J Vasc Surg 1991. [DOI: 10.1016/0741-5214(91)90360-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Toohey AK, LaSalle TL, Martinez S, Polisson RP. Iliopsoas bursitis: clinical features, radiographic findings, and disease associations. Semin Arthritis Rheum 1990; 20:41-7. [PMID: 2218552 DOI: 10.1016/0049-0172(90)90093-u] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Inflammation of the iliopsoas bursa is a common manifestation of a wide array of inflammatory, degenerative, and traumatic musculoskeletal conditions. The clinical presentation of iliopsoas bursitis is variable, and includes pain, mass lesion, or compression syndromes of the inguinal compartment. Affected individuals frequently have underlying synovitis of the hip or a history of occupational or recreational injury. Early and accurate diagnosis is facilitated by appropriate radiographic studies.
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Affiliation(s)
- A K Toohey
- Department of Medicine, Duke University Medical Center, Durham, NC 27710
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Affiliation(s)
- H Wiese
- Department of Radiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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Constant O, Mitchell RA. An unusual inguinal swelling. Br J Radiol 1987; 60:1139-40. [PMID: 3690160 DOI: 10.1259/0007-1285-60-719-1139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- O Constant
- Department of Radiology, Royal Marsden Hospital, London
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Affiliation(s)
- J E Alexander
- University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock
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Sartoris DJ, Danzig L, Gilula L, Greenway G, Resnick D. Synovial cysts of the hip joint and iliopsoas bursitis: a spectrum of imaging abnormalities. Skeletal Radiol 1985; 14:85-94. [PMID: 4023747 DOI: 10.1007/bf00349741] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Synovium-related soft tissue disease around the hip constitutes a spectrum ranging from isolated iliopsoas bursitis to pure articular synovial herniations without bursal involvement. The clinical, pathologic, and radiographic features of these entities are discussed as they pertain to the variety of underlying disorders which predispose to their occurrence. Nine case reports are utilized to illustrate the variable clinical and radiographic presentations which may be encountered. Based upon these cases as well as those in the literature, an imaging algorithm has been developed which should eliminate unnecessary studies and allow prompt and accurate diagnosis.
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Levy RN, Hermann G, Haimov M, Sherry HS, Train JS, Davison S. Rheumatoid synovial cyst of the hip. ARTHRITIS AND RHEUMATISM 1982; 25:1382-4. [PMID: 7138609 DOI: 10.1002/art.1780251118] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Lavyne MH, Voorhies RM, Coll RH. Femoral neuropathy caused by an iliopsoas bursal cyst. Case report. J Neurosurg 1982; 56:584-6. [PMID: 6278108 DOI: 10.3171/jns.1982.56.4.0584] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
✓ This case presents a rare occurrence of femoral neuropathy due to iliopsoas bursitis as a consequence of hip osteoarthritis. A computerized tomography scan of the hip revealed a smooth-walled nonenhancing cystic mass adjacent to the hip joint and elevating the components of the homolateral femoral triangle. The differential diagnosis and operative management of this entity are reviewed.
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Janus C, Hermann G. Enlargement of the iliopsoas bursa: unusual cause of cystic mass on pelvic sonogram. JOURNAL OF CLINICAL ULTRASOUND : JCU 1982; 10:133-135. [PMID: 6804516 DOI: 10.1002/jcu.1870100310] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Ford MJ, Martynoga AG, Nuki G. Iliopsoas bursitis in rheumatoid arthritis: an unusual cause of leg oedema. BRITISH MEDICAL JOURNAL 1981; 282:947-8. [PMID: 6781664 PMCID: PMC1504839 DOI: 10.1136/bmj.282.6268.947] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Beggs I. Iliopsoas Bursa Demonstrated at Femoral Puncture. Med Chir Trans 1980; 73:393-4. [PMID: 7241464 PMCID: PMC1437484 DOI: 10.1177/014107688007300522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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