Iliopsoas Bursitis

Hip OA is common in the elderly, with a characteristic presentation as shown in Table 90-3. However, pain located on the lateral hip typically represents trochanteric bursitis, while pain in the buttock region may indicate lumbar spine OA or iliopsoas bursitis. 

Fig. 12.36a,b. Extension of iliopsoas bursitis within the pelvis, a Axial CT scan demonstrates a large mass (asterisks) filled with hypodense fluid in the left pelvic fossa, close to the ilium. Observe the needle (arrowheads) guided within the mass for percutaneous biopsy, b Coronal Gd-enhanced Tl-weighted MR image reveals an enlarged bursa located, in part, within the pelvic cavity (asterisks) and contrast material uptake by its walls and septa (arrowheads). Pb, pubis... 

Entrapment of the femoral nerve is a rare condition resulting from a variety of space-occupying processes in the iliacus compartments, such as hematoma, iliacus abscess, iliopsoas bursitis or iatrogenic complications after vessel cannulation, during fracture fixation with metallic plates or inguinal hernia repair. In severe neuropathy, wasting and weakness of the quadriceps muscle, a reduced knee reflex and... 

Fig. 12.65a-f. Acetabular cup for hip replacement, a Photograph, b standard radiograph and c in vitro US appearance of an acetabular spiral screwed cup. US depicts the cup as a hyperechoic structure with reverberation artifact characterized by a series of external teeth arrowhead), d-f Schematic drawings of a sagittal view through the anterior hip illustrate d a normally positioned cup, e,f an anterior protruding cup resulting in e iliopsoas bursitis asterisks) and f tears of the undersurface of the iliopsoas muscle arrowheads). A, native acetabulum Ac, acetabular cup H, head of the prosthesis N, neck of the prosthesis F, femoral bone... 

Bianchi S, Martinoli C, Keller A et al (2002b) Giant iliopsoas bursitis ultrasound findings with MRI correlations. J Clin Ultrasound 30 437-441... 

Pellman E, Kumari S, Greenwald R (1986) Rheumatoid iliopsoas bursitis presenting as unilateral leg edema. J Rheumatol 13 197-200... 

Salmeron 1, Cardenas JL, Ramirez-Escobas MA et al (1999) Idiopathic iliopsoas bursitis. Eur Radiol 9 175 Sener RN, Alper H, Ozturk L et al (1991) Retroperitoneal part of the femoral nerve. Normal ultrasound features. Neuroradiology 33 159-161... 

Iliopsoas bursitis is usually punctured under real-time guidance because of its proximity to the femoral vessels and nerve. For this purpose, transverse US planes are the most adequate because they allow concomitant detection of the distended bursa and the adjacent anatomic structures. In total... 

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