Disclosures: Joshua M. Romero, MD: No financial relationships or conflicts of interest

Case Diagnosis: Large Atypical Iliopsoas Bursitis Communicating with Hip Joint

Case Description: A 72-year-old active male was referred to our Physical Medicine & Rehabilitation Musculoskeletal Outpatient Clinic for an ultrasound guided intra-articular hip injection in the setting of hip osteoarthritis and impaired function. Clinical presentation was atypical for diffuse anterior thigh pain. Ultrasonographic evaluation demonstrated a significant hip effusion and an adjacent large hypoechoic mass extending medially. The mass measured over 8 cm in length and lied immediately adjacent to the femoral vasculature. It appeared to be in communication with the hip joint and a very large iliopsoas bursitis was suspected. The injection was deferred, and the patient was referred for an MRI of the hip without IV contrast for further evaluation.

Setting: Tertiary Care Academic HospitalAssessment/

Results: Hip MRI confirmed presence of a large left iliopsoas bursitis, measuring 7.6 x 9.1 cm, extending postero-medially, and in communication with the hip joint. No other suspicious lesions were identified. The patient underwent an ultrasound-guided iliopsoas aspiration and intra-articular hip injection; 25 mL of clear blood-tinged fluid was aspirated.

Discussion: The iliopsoas bursa, the largest bursa of the body, communicates with the coxofemoral joint in 15% of persons normally. Communication may occur in up to 40% of cases when associated with disease such as osteoarthritis, avascular necrosis, pigmented villonodular synovitis and pyogenic infection. Differential diagnosis includes hernia, psoas abscess, femoral aneurysm, and neoplasm. MRI is the gold standard for a thorough evaluation. Complications may occur secondary to compression of adjacent structures. Treatment includes physical therapy, bursa aspiration with corticosteroid injection, and bursectomy for refractory cases.

Conclusion: Iliopsoas bursitis should be considered in patients presenting with anterior hip and thigh pain in the setting of hip osteoarthritis. A thorough evaluation is recommended to rule out other potential serious associated pathologies and complications, in particular in the presence of a large, distended bursa.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/ultrasound-findings-of-an-atypical-iliopsoas-bursitis-a-case-report/