Bursae and abscess cavities communicating with the hip. Diagnosis using arthrography and CT.

Abstract

Bursae or abscess cavities communicating with the hip joint were demonstrated by hip arthrography or by computed tomography (CT) in 40 cases. The bursae or abscess cavities were associated with underlying abnormalities in the hip, including painful hip prostheses, infection, and inflammatory or degenerative arthritis. Structures communicating with the joint capsule included iliopsoas bursae (13 cases), bursae associated with the greater trochanter (21 cases), ischiotrochanteric bursae created by abnormal articulation between the ischium and lesser trochanter (two cases), and abscess cavities not associated with a bursa (four cases). Symptoms may be produced directly as a result of infection or indirectly as a result of inflammation or pressure on adjacent structures. In cases of suspected infection, direct puncture and aspiration of the bursa or abscess cavity, in addition to joint aspiration, may be necessary to obtain organisms for culture as joint aspiration may not yield fluid. Hip arthrography can confirm a diagnosis of bursae and abscess cavities communicating with the hip joint in patients with hip pain or soft-tissue masses around the groin. Differentiation of enlarged bursae from other abnormalities is important to avoid unnecessary or incorrect surgery.

Obturator externus bursa: prevalence of communication with the hip joint and associated intra-articular findings in 200 consecutive hip MR arthrograms

“…As such, the actual normal overall prevalence of communication between the hip joint and the obturator externus bursa is still unknown, as it is possible (and perhaps likely) that the 5.5% prevalence of such communication in our cohort is actually higher than that in the normal population given the presence of intra-articular disease in all our patients. This may be similar to the increased prevalence of communication between the hip joint and the ilio-psoas bursa in the presence of intra-articular disease [5,6].…”

“…Otherwise, the presence of the intraarticularly administered gadolinium in one of these adjacent structures may be mistaken for disease. The classic example is the potential normal communication that can be seen between the hip joint and the ilio-psoas bursa [4,5]. One must be careful to recognise such communication as a potentially normal variant of anatomy.…”

“…Variants in the anatomy of the labrum have previously been described [3]. In addition, the presence of normal communication between the hip joint and the ilio-psoas bursa is a well-known variant that can be seen in approximately 15% of the population [4,5]. Although the presence of communication between the hip joint and the obturator externus bursa has been described, the prevalence of this communication is not clear [6,7].…”

Abductor muscle necrosis due to iliopsoas bursal mass after total hip arthroplasty

“…1, [3][4][5]7,13 This fluid migration may stem from a communicating iliopsoas bursa, especially in those patients with pre-existing connections between the capsule and bursa. The prevalence of such connections amongst patients with pre-existing hip pathology may be greater than 15%.…”

“…[1][2][3][4] Although predominantly associated with implant wear and pressure-driven migration of periarticular fluid into the iliopsoas bursa, 4,5 bursal-related complications may also result from direct frictional forces with mal-positioned or prominent hip implants. Large cystic bursal masses may present as inguinal masses, with or without pain, and in some cases, may cause femoral neurovascular compression and/or lower limb edema.…”