Skip to main content

Advertisement

SpringerLink
Log in

Iliopsoas bursal extension of lipohemarthrosis: A novel imaging finding associated with hip fracture

  • Case Report
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Lipohemarthrosis is well known to be associated with intra-articular fractures throughout the body. Despite the relatively common occurrence of hip fracture and the frequency of communication between the hip joint and iliopsoas bursa, to the best of our knowledge, a fat-fluid level involving the iliopsoas bursa secondary to a hip fracture has not previously been reported. The following is a case report of a 48-year-old male who sustained an acute femoral neck fracture and was found to have distension of the iliopsoas bursa with a fat-fluid level resulting from extra-capsular extension of a lipohemarthrosis. The imaging findings, relevant anatomy, and potential importance of this finding for the detection of hip fracture are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Kling DH. Fat in traumatic effusions of the knee joint. Am J Surg. 1929;6(1):71–4.

  2. Holmgren BS. Rontgenologisch beobachtete niveaus zwischen blut und fett im kniegelenk bei intraartikulãrer fraktur. Upsala Lakarefõrenings Forhandlingar 1939;139–142.

  3. Peirce CB, Eaglesham ED. Traumatic lipohemarthrosis of the knee. Radiology. 1942;39(6):655–62.

    Article  Google Scholar 

  4. Chandler SB. The iliopsoas bursa in man. Anat Rec. 1934;58:235–40.

    Article  Google Scholar 

  5. Gatch WD, Green WT. Cysts of the ilio-psoas bursa. Ann Surg. 1925;82(2):277–85.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Sartoris DJ, Danzig L, Gilula L, Greenway G, Resnick D. Synovial cysts of the hip joint and iliopsoas bursitis: a spectrum of imaging abnormalities. Skelet Radiol. 1985;14(2):85–94.

    Article  CAS  Google Scholar 

  7. Garden RS. Malreduction and avascular necrosis in subcapital fractures of the femur. J Bone Joint Surg (Br). 1971;53:183–97.

    Article  CAS  Google Scholar 

  8. Arger PH, Oberkircher PE, Miller WT. Lipohemarthrosis. AJR. 1974;121(1):97–100.

    Article  CAS  Google Scholar 

  9. Costa DN, Cavalcanti CFA, Sernik RA. Sonographic and CT findings in lipohemarthrosis. AJR. 2007;188:W389.

    Article  PubMed  Google Scholar 

  10. Lugo-Olivieri CH, Scott Jr WW, Zerhouni EA. Fluid-fluid levels in injured knees: do they always represent lipohemarthrosis? Radiology. 1996;198(2):499–502.

    Article  CAS  PubMed  Google Scholar 

  11. Bianchi S, Zwass A, Abdelwahab IF, Ricci G, Rettagliata F, Olivieri M. Sonographic evaluation of lipohemarthrosis: clinical and in vitro study. J Ultrasound Med. 1995;14(4):279–82.

    CAS  PubMed  Google Scholar 

  12. Geijer M, Dunker D, Collin D, Gothlin JH. Bone bruise, lipohemarthrosis, and joint effusion in CT of nondisplaced hip fracture. Acta Radiol. 2012;53(2):197–202.

    Article  PubMed  Google Scholar 

  13. Egund N, Nilsson LT, Wingstrand H, et al. CT scans and lipohaemarthrosis in hip fractures. J Bone Joint Surg (Br). 1990;72-B:379–82.

    Google Scholar 

  14. Strange-Vognsen HH, Neergaard K, Schantz K. CT scan compared to tomography in suspected hip fracture. Arch Orthop Trauma Surg. 1992;111(2):124–5.

    Article  CAS  PubMed  Google Scholar 

  15. Wingstrand H, Strömqvist B, Egund N, et al. Hemarthrosis in undisplaced cervical fractures. Tamponade may cause reversible femoral head ischemia. Acta Orthop Scand. 1986;57(4):305–8.

    Article  CAS  PubMed  Google Scholar 

  16. Lee JH, Weissman BN, Nikpoor N, Aliabadi P, Sosman JL. Lipohemarthrosis of the knee: a review of recent experience. Radiology. 1989;173(1):189–91.

    Article  CAS  PubMed  Google Scholar 

  17. Le Corroller T, Parratte S, Zink J-V, Argenson J-N, Champsaur P. Floating fat in the wrist joint and in the tendon sheaths. Skelet Radiol. 2010;39:931–3.

    Article  Google Scholar 

  18. McConnell M, Cohen H, Scuderi M. Non-displaced distal radius fractures with fat-fluid levels in the adjacent extensor tendon sheaths on MRI. Skelet Radiol. 2013;42:1761–5.

    Article  Google Scholar 

  19. Chang G, Hughes T, Resnick D. Computed tomography (CT) of fractures of the ankle and foot: correlating fracture patterns with the presence of tenosynovial fat. Clin Imaging. 2014;38:160–3.

    Article  PubMed  Google Scholar 

  20. Finder JG. Iliopectineal bursitis. Arch Surg. 1938;36:519–30.

    Article  Google Scholar 

  21. Skiadas V, Koutoulidis V, Plotas A. An atypical case of noninfected iliopsoas bursitis—MRI findings. J Radiol Case Rep. 2009;3(10):15–8.

    PubMed  PubMed Central  Google Scholar 

  22. Shabshin N, Rosenberg ZS, Cavalcanti CFA. MR imaging of iliopsoas musculotendinous injuries. Mag Res Clin N Am. 2005;13(4):705–16.

    Article  Google Scholar 

  23. Johnston CAM, Wiley JP, Lindsay DM, Wiseman DA. Iliopsoas bursitis and tendinitis: a review. Sports Med. 1998;25(4):271–83.

    Article  CAS  PubMed  Google Scholar 

  24. Kozlov DB, Sonin AH. Iliopsoas bursitis: diagnosis by MRI. J Comput Assist Tomogr. 1998;22(4):625–8.

    Article  CAS  PubMed  Google Scholar 

  25. Melamed A, Bauer CA, Johnson JH. Iliopsoas bursal extension of arthritic disease of the hip. Radiology. 1967;89(1):54–8.

    Article  CAS  PubMed  Google Scholar 

  26. Wunderbaldinger P, Bremer C, Schellenberger E, et al. Imaging features of iliopsoas bursitis. Eur Radiol. 2002;12:409–15.

    Article  CAS  PubMed  Google Scholar 

  27. Carr CR, Berley FV, Davis WC. Pigmented villonodular synovitis of hip joint: case report. J Bone Joint Surgery. 1954;36(5):1007–13.

    Article  Google Scholar 

  28. Weisser JR, Robinson DW. Pigmented villonodular synovitis of iliopectineal bursa: case report. J Bone Joint Surg. 1951;33(4):988–92.

    Article  PubMed  Google Scholar 

  29. Torres GM, Cernigliaro JG, Abbitt PL, et al. Iliopsoas compartment: normal anatomy and pathologic processes. Radiographics. 1995;15(6):1285–97.

    Article  CAS  PubMed  Google Scholar 

  30. Muttarak M, Peh WCG. CT of unusual iliopsoas compartment lesions. Radiographics. 2000;20:S53–66.

    Article  PubMed  Google Scholar 

  31. Bogost GA, Lizerbram EK, Crues 3rd JV. MR imaging in evaluation of suspected hip fracture: frequency of unsuspected bone and soft-tissue injury. Radiology. 1995;197:263–7.

    Article  CAS  PubMed  Google Scholar 

  32. Dominguez S, Liu P, Roberts C, Mandell M, Richman PB. Prevalence of traumatic hip and pelvic fractures in patients with suspected hip fracture and negative initial standard radiographs—a study of emergency department patients. Acad Emerg Med. 2005;12:366–9.

    PubMed  Google Scholar 

  33. Kirby MW, Spritzer C. Radiographic detection of hip and pelvic fractures in the emergency department. AJR. 2010;194:1054–60.

    Article  PubMed  Google Scholar 

  34. Dunker D, Collin D, Gothlin JH, Geijer M. High clinical utility of computed tomography compared to radiography in elderly patients with occult hip fracture after low-energy trauma. Emerg Radiol. 2012;19:135–9.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Musculoskeletal Imaging & Intervention, Department of Radiology, Brigham & Women’s Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA

    Gregory J. Czuczman & Jacob C. Mandell

  2. Division of Emergency Radiology, Department of Radiology, Brigham & Women’s Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA

    Bharti Khurana

Authors
  1. Gregory J. Czuczman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jacob C. Mandell
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bharti Khurana
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gregory J. Czuczman.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Czuczman, G.J., Mandell, J.C. & Khurana, B. Iliopsoas bursal extension of lipohemarthrosis: A novel imaging finding associated with hip fracture. Skeletal Radiol 46, 253–257 (2017). https://doi.org/10.1007/s00256-016-2532-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-016-2532-2

Keywords

Search

Navigation