Radiology Teaching Files > Case 183581

Contributed by: Herman Wu, Radiologist, University of California, San Diego, California, USA.
Patient: 47 year old female
History: 47 year old female with cystic mass of the right iliopsoas muscle.

Fig. 1: Coronal T2 FSE image shows an elongated fluid-intensity structure in the right abdomen and pelvis.

Fig. 2: Sagittal T2 FSE image: the fluid-signal lesion extends anterior to the right hip joint. The associated iliopsoas tendon can be seen posteriorly.

Fig. 3: The next 4 images are taken from axial T2 FSE with fat saturation sequence. The iliopsoas tendon can be well seen in these images, invaginating into the bursal fluid collection.

Fig. 4

Fig. 5

Fig. 6

Fig. 7: The next 3 images from post-Gd axial T1 with fat saturation demonstrate rim enhancement to the lesion, confirming its fluid contents.

Fig. 8: There is focal loculated extension of the bursal fluid deep to the right obturator internus muscle.

Fig. 9

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.

References: Kozlov DB, Sonin AH. Iliopsoas bursitis: diagnosis by MRI. Journal of Computed Assisted Tomography 1998: 22(4); 625-628.
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Additional Details:

Case Number: 183581Last Updated: 10-16-2003
Anatomy: Skeletal System   Pathology: Non-Infectious Inflammatory Disease
Modality: MRExam Date: 10-13-2003Access Level: Readable by all users

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