| Discussion: |
The iliopsoas bursa is the largest bursal sac in the body; in 15% of normal individuals, it communicates with the hip joint between the iliofemoral and pubofemoral ligaments. In patients with hip pathology, there is a 30-40% frequency of communication between the two structures.
Iliopsoas bursitis can be caused by various hip joint abnormalities such as joint degeneration, rheumatoid arthritis, PVNS, synovial osteochondromatosis, gout, joint infection, or avascular necrosis. Other possible underlying causes include sacro-iliac joint pathology and adjacent spine pathology (in this case, underlying TB was considered based on clinical grounds). If there are no imaging findings of an underlying cause (as in this case), fluid aspiration and analysis may be needed for definitive analysis.
Treatment usually consists of aspiration initially, followed by injection of steroids, anaesthetics, or sclerosing agents. With recurrent or complicated cases, surgical bursectomy with possible hip joint capsulotomy or synovectomy may be needed.