An atypical case of noninfected iliopsoas bursitis - MRI findings

Abstract

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.

Sonographic assessment of the anatomy and common pathologies of clinically important bursae

“…Iliopsoas bursa communicates with the hip joint in 15% of adults (16) , and an enlarged bursa can be a consequence of hip pathology: osteoarthritis, inflammatory disease etc. (17) , or primary bursitis.…”

Gas-containing iliopsoas bursitis in the setting of degenerative osteoarthritis

“…Various theories have been proposed as to the aetiology of iliopsoas bursitis in the setting of certain hip pathologies including overproduction of fluid in a pathological hip joint with protrusion of synovium into the iliopsoas bursa, displacement of synovium in the embryonal stage, direct communication of the iliopsoas bursa and the hip joint, hypertrophy of the iliopsoas bursa lining with subsequent fluid accumulation, or an acquired communication of the iliopsoas bursa to the hip joint from degenerative changes to their walls and surrounding connective tissue due to age and concomitant pathology 2–5. Histologically, there are at least two different types of cysts that can occur around a joint or tendon and these are referred to as ganglion and synovial cysts.…”

“…The primary differential diagnosis for masses in the inguinal region includes inguinal lymphadenopathy, femoral or inguinal hernia, psoas abscess, undescended testes, pigmented villonodular synovitis, synovial chondromatosis and vascular abnormalities of femoral vessels such as femoral artery aneurysm. In addition, the differential diagnosis for iliopsoas bursitis includes avascular necrosis of the femoral head, osteoarthritis, rapidly destructive arthrosis of the hip, rheumatoid arthritis, polymyalgia rheumatica, labral tears, snapping hip syndrome and repetitive trauma 2 5…”

Bilateral giant hip cysts in a woman: an atypical presentation and a diagnostic challenge

“…CT has the advantage of a higher spatial resolution, while the MRI is superior to other imaging modalities for soft tissue abnormalities, especially in assessing the exact location and the involvement of other structures around the cyst. [6][7][8] Histopathology assessment can ultimately be confirmatory to distinguish a synovial cyst from haemangioma, lymphangioma and other malignant tumours.…”

“…Also, treating the underlying pathology such as rheumatoid arthritis with prednisone and methotrexate can effectively relieve the symptoms. [8][9][10] However, when the patient develops significant complications due to compression onto the nerve, vein, artery or ureter by the enlarged cyst, invasive interventions are often required that include the options of needle puncture and aspiration or surgical resection. Surgical resection of the synovial cyst is effective to restore normal venous return and relieve symptoms subsequently.…”