A case of femoral nerve palsy caused by iliopectineal bursitis associated with rheumatoid arthritis

Advanced osteoarthritis of the hip as reason for extensive asymmetric leg edema: a rare case report and review of the literature

An enlarged iliopectineal bursa (IB) can cause pressure on iliofemoral veins. Clinical presentation can manifest as asymmetrical lower extremity edema. This case report demonstrates extensive asymmetrical leg edema caused by femoral vein compression based on iliopectineal bursitis (IB-itis) associated with advanced osteoarthritis (OA) of the left hip joint with an outline of relevant current literature. A female patient presented with left hip pain and edema in the leg. X-ray showed severe OA of the left hip. Computed Tomography (CT) concluded a cystic abnormality at the left iliopsoas muscle associated with the joint consistent with IB-itis, associated with a degenerative left hip joint. Hybrid total hip replacement was performed. At three-month follow-up her left leg showed no longer signs of extensive edema and she walked without the use of walking aids. IB-itis is mostly associated with rheumatoid arthritis (RA). There are no reports which only describe OA as cause of IB-itis. Extensive asymmetrical leg edema can be caused by venous compression of the femoral vein by an IB-itis. If the latter is the consequence of advanced hip OA, a total hip replacement can yield excellent clinical outcomes both functionally and with regard to the edema.

Endoscopic Resection for Iliopectineal Bursitis Associated With Developmental Dysplasia of the Hip

Iliopectineal bursitis usually develops subsequent to other hip pathologies and can often be treated conservatively. However, when conservative treatment fails or the enlarged bursa causes pain or compression of the surrounding neurovascular structures, surgery may be required. Most previous studies have described open surgeries, and reports on endoscopy are very limited. We present a case of iliopectineal bursitis associated with developmental dysplasia of the hip (DDH) that was successfully treated endoscopically. A 16-year-old female with a one-year history of right inguinal pain was referred to our department. She was diagnosed with a hip ganglion and treated with needle aspiration nine times by her previous doctor. Radiographs revealed bilateral DDH without narrowing of the joint space. Magnetic resonance imaging revealed a distinct mass in the deep layer of the iliopsoas muscle, and communication between the mass and the hip joint was observed on ultrasonography. Endoscopic debridement and resection were performed based on the diagnosis of iliopectineal bursitis. We partially debrided the medial side of the rectus femoris muscle toward the deep layer and resected the bursa. We observed a burst of concentrated content from the bursa and confirmed the disappearance of the mass by intraoperative ultrasonography. The postoperative course was good, and there were no functional restrictions or symptom recurrence at two-year postoperatively. Endoscopic resection for repetitive iliopectineal bursitis without an intraarticular procedure does not induce hip instability in patients with DDH and is a minimally invasive cosmetic procedure, and superior to open surgery, especially in young women.

An Unusual Association: Iliopsoas Bursitis Related to Calcium Pyrophosphate Crystal Arthritis

A 71-year-old man with osteoarthritis and chondrocalcinosis came to our observation developing a swelling in the groin region after a recent left colectomy for adenocarcinoma. The imaging techniques revealed the presence of an iliopsoas bursitis in connection with the hip. The synovial fluid analysis detected the presence of calcium pyrophosphate (CPP) crystals and allowed the final and unusual diagnosis of iliopsoas bursitis related to acute CPP crystal hip arthritis.

Giant iliopectineal bursitis presenting as neuropathy and severe edema of the lower limb: case illustration and review of the literature

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.

Femoral nerve palsy caused by ileopectineal bursitis after total hip replacement: a case report

Introduction

Infectious ileopectineal bursitis is a rare complication after total hip replacement and is associated mainly with rheumatoid arthritis. The main complications are local swelling and pain, but communication of the inflamed bursa with the joint can occur, leading to subsequent cartilage damage and bone destruction.

Case presentation

We report a case of a 47-year-old Caucasian woman without rheumatoid arthritis who reported pain and palsy in her left leg almost one year after total hip replacement. She was diagnosed with an ileopectineal bursitis after total hip replacement, leading to femoral nerve palsy. The diagnosis was obtained by thorough clinical examination, the results of focused computed tomography and magnetic resonance imaging.

Conclusion

To the best of our knowledge, this is the first report of non-infectious ileopectineal bursitis in a patient without rheumatoid arthritis as a complication of total hip replacement. This rare case underlines the importance of proper neurologic examination of persistent conditions after orthopedic intervention in otherwise healthy individuals. We believe this case should be useful for a broad spectrum of medical specialties, including orthopedics, neurology, radiology, and general practice.

An atypical case of noninfected iliopsoas bursitis - MRI findings

The authors present an unusual case of atypical iliopsoas bursitis in an 81 years-old female patient. The patient asked for medical advice due to a chronic left hip and lower abdominal pain with no specific characteristics. Physical examination revealed a palpable left-sided pelvic mass. Ultrasound examination demonstrated a purely cystic mass that was presumed to be an ovarian cystic malignancy. The patient was referred for an MRI examination, which showed a cystic lesion extending from the left iliac crest to the anterior aspect of the ipsilateral hip joint (maximum diameter 18 cm), coursing below the iliopsoas tendon indicative of an extremely distended iliopsoas bursa.