Pseudotumour in the bladder as a complication of total hip replacement: ultrasonography, CT and MR findings

Park, S J; Lee, H K; Yi, Beom Ha; Chi, J G; Kim, H C; Lee, K W; Kim, M E; Kwon, Geeyoun

doi:10.1259/bjr/64765826

Cited by 9 publications

(2 citation statements)

References 5 publications

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“…19 Interestingly, a pseudotumor has been reported in the urinary bladder, thought to be secondary to cement extrusion through acetabular defects. 20 On ultrasound, ALTR may appear as an anechoic or hypoechoic fluid collection with little vascularity, which may demonstrate thick echogenic septations and marked synovial hypertrophy (►Fig. 2a).…”

Section: Altr/pseudotumormentioning

confidence: 99%

Metal-on-Metal Total Hip Arthroplasty Associated with Adverse Local Tissue Reaction and Pseudoaneurysm of the Superior Gluteal Artery: A Case Report and Literature Review

Shah

Botchu

Dunlop

et al. 2016

Surg J

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Hip arthroplasty is a common procedure, with nearly 70,000 operations in the United Kingdom in 2014.1 Traditional metal-on-polyethylene (MoP) components generate particulate debris, leading to an inflammatory response and resulting in osteolysis and aseptic loosening. To overcome this, metal-on-metal (MoM) devices have increased in popularity, especially in young patients, with the aim of potentially improving wear rates compared with MoP implants. 2 There are several potential complications including postoperative joint effusion, iliopsoas bursitis, tendinitis or impingement, and gluteal tendinopathy. Two rare complications include the formation of a pseudotumor or adverse local tissue reaction (ALTR) and pseudoaneurysm. We present a case of an asymptomatic patient with a MoM total hip arthroplasty (THA) with an ALTR and pseudoaneurysm of the superior gluteal artery found incidentally during ultrasound assessment for raised serum metal ions. To the best of our knowledge, this is the first reported case in the Keywords ► metal-on-metal hip arthroplasty ► adverse local tissue reaction ► pseudotumor ► pseudoaneurysm ► superior gluteal artery AbstractAdverse local tissue reaction (ALTR) and pseudoaneurysm formation are rare but known complications following metal-on-metal hip total hip arthroplasty (THA). We report the first known case in the English literature of a concurrent unilateral ALTR and pseudoaneurysm of the superior gluteal artery in the same patient. Following minimal rise in serum metal ions, an ultrasound of the right hip demonstrated an avascular solid/cystic lesion anterolaterally in keeping with an ALTR. More posterolaterally, a second discrete thick-walled cystic lesion was identified. Doppler interrogation demonstrated a "yin yang" pattern suggestive of a pseudoaneurysm. Magnetic resonance imaging confirmed the presence of an anterolateral periarticular lesion with a second discrete lesion within the gluteus medius. Subsequent computed tomography angiography confirmed the presence of arterial contrast blush within the posterior gluteal lesion adjacent to the superior gluteal artery. The patient remains asymptomatic and is being managed conservatively. We review the imaging characteristics of ALTR and pseudoaneurysm occurring post-THA. When a complex solid/cystic lesion is encountered in a patient with a THA, radiologists must ensure that the lesion is interrogated with color Doppler to confidently distinguish a pseudotumor from a pseudoaneurysm. This information is vital to the surgeon to avoid unexpected hemorrhage if revision joint replacement surgery is being contemplated.

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Section: Altr/pseudotumormentioning

confidence: 99%

Metal-on-Metal Total Hip Arthroplasty Associated with Adverse Local Tissue Reaction and Pseudoaneurysm of the Superior Gluteal Artery: A Case Report and Literature Review

Shah

Botchu

Dunlop

et al. 2016

Surg J

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“…Bone cement penetrating into the bladder was found in two of these three cases. 1 However, periprosthetic pseudotumor has been a well-known complication after hip replacement in recent years. 2 It is hypothesized that pseudotumors are caused by a foreign body reaction to wear debris including polyethylene (a component of the bearing surface), metal (a component of the bearing surface) or methylmethacrylate (a component of bone cement).…”

mentioning

confidence: 99%

Recurrent pseudotumor of the urinary bladder managed by revision hip arthroplasty

Lee

2012

Int J of Urology

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Ultrasonography of the Pediatric Bladder

2013

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Pseudotumour in the bladder as a complication of total hip replacement: ultrasonography, CT and MR findings

Cited by 9 publications

References 5 publications

Metal-on-Metal Total Hip Arthroplasty Associated with Adverse Local Tissue Reaction and Pseudoaneurysm of the Superior Gluteal Artery: A Case Report and Literature Review

Metal-on-Metal Total Hip Arthroplasty Associated with Adverse Local Tissue Reaction and Pseudoaneurysm of the Superior Gluteal Artery: A Case Report and Literature Review

Recurrent pseudotumor of the urinary bladder managed by revision hip arthroplasty

Ultrasonography of the Pediatric Bladder

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