Iliopsoas bursitis demonstrated by computed tomography

Cystic lesion around the hip joint

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.

[Femoral superficial vein thrombosis due to a large iliopsoas bursitis secondary to polyethylene wear debris in total hip arthroplasty]

A 76 year old male patient with a history of implantation of a total hip arthroplasty Perfecta (Orthomet(®)), who presented with an iliac fossa mass, increased diameter of the thigh, and pain during hip flexion and extension. CT and ultrasound show the presence of a giant cystic mass in left iliac fossa about 7 cm in diameter next to the prosthesis. A pseudo-tumour secondary to wear debris after placement of a total arthroplasty is rare. We present a case of a large iliopsoas bursitis caused by polyethylene particles, which caused compression and thrombosis of the superficial femoral vein.

Pelvic mass caused by polyethylene wear after uncemented total hip arthroplasty

A 50-year-old man developed a pelvic mass following uncemented total hip arthroplasty. The mass communicated with the hip via an acetabular defect after loosening of the acetabular component. Operative and histologic findings revealed a foreign body reaction to polyethylene debris. Revision arthroplasty and excision of the pelvic mass were performed successfully through a single incision. A mass adjacent to a loose prosthesis may present as polyethylene failure following total hip arthroplasty. Revision arthroplasty and excision of the mass after an accurate diagnosis are recommended.

Iliopsoas bursa of the rheumatoid hip joint. A case report and review of the literature

Presented is the case of a 63-year-old woman, with a 30-year history of rheumatoid arthritis, whose hip was completely destroyed and accompanied with enlargement of the iliopsoas bursa. Preoperative diagnosis was confirmed by computed tomography, magnetic resonance (MR) imaging and arthrography. She was treated by resection of the iliopsoas bursa and total prosthetic replacement of the hip joint. The pathogenesis is uncertain. In the literature, enlargement of the iliopsoas bursa with rheumatoid arthritis, osteoarthritis, pigmented villonodular synovitis, and synovial chondromatosis had been reported. Nevertheless, a correct preoperative diagnosis of the enlargement of the iliopsoas bursa is very difficult. MR imaging with enhanced Gadolinium-DTPA (Gd-DTPA) is proposed as the most useful examination for preoperative diagnosis.

Distended iliopsoas bursa: case reports and anatomical dissection

Distension of the iliopsoas bursa is usually seen in association with underlying hip joint disease. The computed tomography (CT) appearance is characteristic and allows a diagnosis to be readily made. Computed tomography will also facilitate needle placement for aspiration of bursa contents and the injection of water-soluble contrast media for CT bursography. Three cases of iliopsoas bursa enlargement of varying underlying aetiology are presented. The dissection of seven cadavers demonstrated the anatomy of the normal bursa and highlighted its important role in the normal functioning of the iliopsoas muscle.

Ilio-psoas bursa enlargement

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.

Infective iliopsoas bursitis. A case report

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.

Iliopsoas bursitis: clinical features, radiographic findings, and disease associations

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.

Iliopsoas injury in soccer players

Injuries to the iliopsoas muscle are rarely mentioned in the literature dealing with soccer-related trauma. This report describes our experience in the successful diagnosis and treatment of iliopsoas injury in 40 professional soccer players. These injuries were not associated with direct external trauma to the muscle. Anatomical and functional characteristics of the iliopsoas are reviewed as they relate to the diagnosis and to the treatment by direct local injection with corticosteroids. A safe anatomical approach to the iliopsoas below the inguinal ligament is described.

Synovial cysts of the hip joint and iliopsoas bursitis: a spectrum of imaging abnormalities

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.