Diagnosis of iliopsoas bursitis in a veteran with right lower abdominal pain: A case report

Abstract

Background:The iliopsoas bursa is the largest bursa in the body, is present in the majority of people, and is located between the psoas tendon and the hip joint. Iliopsoas bursitis (IB) can be associated with hip osteoarthrosis, trauma, overuse, infection, and inflammatory arthropathies.IB may cause pain in the lower abdomen, groin, or knee, and pathologies involving the iliopsoas can cause positive psoas and obturator signs.On physical exam, IB may be confused for a hernia or an aneurysm as it may present as a mass lesion in the groin and can transmit pulsations from the nearby femoral artery. Given these nonspecific presentations, IB is an often-overlooked cause of pain.Case Presentation: A 45-year-old, male veteran presented to the emergency room with right lower quadrant (RLQ) abdominal pain. Medical history was significant only for chronic right hip pain related to osteoarthrosis (OA). Vital signs were normal, and the exam was notable for tenderness to palpation in the right lower quadrant and inguinal region without peritoneal signs. Axial, coronal, and sagittal views on CT scan showed a lobulated fluid attenuation in the typical location of the iliopsoas bursa with an associated hip joint effusion. The diagnosis of iliopsoas bursitis explained the patient's symptoms and the emergency room physician discharged the patient with conservative measures. Discussion and Conclusions:Given the high morbidity and mortality associated with many causes of RLQ pain, a definitive diagnosis is aggressively pursued to ensure appropriate treatment. Musculoskeletal disorders such as iliopsoas bursitis can also be a source of RLQ pain but can be easily overlooked on CT. Medical providers interpreting imaging should be aware of the CT findings of iliopsoas bursitis as it can be a cause of RLQ pain.