Skip to main content
European Spine Journal logoLink to European Spine Journal
. 1997 Sep;6(5):336–341. doi: 10.1007/BF01142682

Iliopsoas bursitis and pseudogout of the knee mimicking L2-L3 radiculopathy: case report and review of the literature

A T Al-Khodairy 1,, C Gobelet 1, R Nançoz 1, J De Preux 3
PMCID: PMC3454611  PMID: 9391806

Abstract

We report the case of a 74-year-old woman who presented with acute-onset right groin pain irradiating to the thigh anteriorly after having suffered for a few weeks from slight knee pain. As a CT scan showed multiple herniated intervertebral discs and spinal stenosis at the L3–L4 level, she was referred to a neurosurgical unit with the tentative diagnosis of L2-L3 radicular pain. Investigations (MR, myelography with CT scan) showed severe acquired lumbar canal stenosis. Decompression surgery was finally postponed because of the patient's serious cardiac medical history and she was referred to us for conservative treatment. She was found to have iliopsoas bursitis with chondrocalcinosis of the knee. Local steroid injections of the two sites abolished her symptoms. We draw attention to the possible pitfalls that the radiographic appearance and one of the multiple clinical presentations of this unrare pathology may represent. Whenever a patient comes walking with crutches, avoids puting weight on his or her leg, and radicular pain is suspected, we advise consideration of other extra-spinal causes for the pain.

Key words: Iliopectineal bursitis, Chondrocalcinosis, Pseudogout, Calcium pyrophosphate dihydrate, Spinal stenosis

Full Text

The Full Text of this article is available as a PDF (1.1 MB).

References

  • 1.Armstrong P, Saxton H. Iliopsoas bursa. Br J Radiol. 1972;45:493–495. doi: 10.1259/0007-1285-45-535-493. [DOI] [PubMed] [Google Scholar]
  • 2.Atkinson MH. Rheumatoid synovial cyst of the hip: an unusual cause of leg swelling (letter) J Rheumatol. 1986;13:986–987. [PubMed] [Google Scholar]
  • 3.Bagnolesi P, Cilotti A, Camerini E. Distension of the mucous bursa of the iliopsoas muscle: a rare expansive process of the pelvic cavity. Radiol Med (Torino) 1989;77:559–561. [PubMed] [Google Scholar]
  • 4.Bates D, Ruggieri P. Imaging modalities for evaluation of the spine. Radiol Clin North Am. 1991;2:675–687. [PubMed] [Google Scholar]
  • 5.Berquist TH, Bender CE, Maus TP, Ward EM, Rand JA. Pseudobursae: a useful finding in patients with painful hip arthroplasty. Am J Roentgenol. 1987;148:103–106. doi: 10.2214/ajr.148.1.103. [DOI] [PubMed] [Google Scholar]
  • 6.Binek R, Levinsohn EM. Enlarged iliopsoas bursa: an unusual cause of thigh mass and hip pain. Clin Orthop. 1987;224:158–163. [PubMed] [Google Scholar]
  • 7.Biundo JJ. Regional rheumatic pain syndromes. In: Schumacher HR, editor. Primer on the rheumatic diseases. Atlanta: Arthritis Foundation; 1988. pp. 263–274. [Google Scholar]
  • 8.Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW. Abnormal magnetic resonance scans of the lumbar spine in asymptomatic patients. J Bone Joint Surg [Am] 1990;72:403–408. [PubMed] [Google Scholar]
  • 9.Braun M. La bursite de Filiopsoas: une cause de cruralgie méconnue. Rev Med Suisse Rom. 1990;110:753–756. [PubMed] [Google Scholar]
  • 10.Bywaters EGL. Lesions of bursae, tendons and tendon sheaths. Clin Rheum Dis. 1975;5:883–926. [Google Scholar]
  • 11.Carr CR, Berley FV, Davis WC. Pigmented villonodular synovitis of the hip joint. J Bone Joint Surg [Am] 1954;36:1007–1013. [PubMed] [Google Scholar]
  • 12.Chaiamnuay P, Davis P. An unusual case of inguinal swelling. Arthritis Rheum. 1984;27:239–240. doi: 10.1002/art.1780270222. [DOI] [PubMed] [Google Scholar]
  • 13.Chandler SB. The iliopsoas bursa in man. Anat Rec. 1934;58:215–218. [Google Scholar]
  • 14.Chilton CP, Darke SG. External iliac venous compression by a giant iliopsoas rheumatoid bursa. Br J Surg. 1980;67:641. doi: 10.1002/bjs.1800670911. [DOI] [PubMed] [Google Scholar]
  • 15.Cohen JM, Hodges SC, Weinreb JC, Muschler G. MR imaging of iliopsoas bursitis and concurrent avascular necrosis of the femoral head. J Comput Assist Tomogr. 1985;9:967–971. doi: 10.1097/00004728-198509000-00028. [DOI] [PubMed] [Google Scholar]
  • 16.Coventry MK, Polley HF, Weiner AD. Rheumatoid synovial cyst of the hip. J Bone Joint Surg [Am] 1959;41:721–730. [PubMed] [Google Scholar]
  • 17.Cullen TS. A large cystic tumor developing from the iliopsoas bursa. JAMA. 1910;54:1181–1184. [Google Scholar]
  • 18.Cyriax J. Psoas bursitis. Textbook of orthopaedic medicine. London: Baillière Tindall; 1982. p. 354. [Google Scholar]
  • 19.Dyon JF, Ben Salah S, Baudin P, Marliave H, Delannoy P. A propos d'une tumeur de l'abdomen de nature exceptionnelle. Kyste synovial de la region iliaque développé de la bourse du psoas. Chir Pédiatr. 1987;28:115–119. [PubMed] [Google Scholar]
  • 20.Eisenberg KS, Johnston JO. Synovial chondromatosis of the hip joint presenting as an intrapelvic mass. J Bone Joint Surg [Am] 1972;54:176–178. [PubMed] [Google Scholar]
  • 21.Finder JG. Iliopectineal bursitis. Arch Surg. 1938;36:519–530. [Google Scholar]
  • 22.Finesson BE. A lumbar disc surgery predictive score card. Spine. 1978;3:186–188. doi: 10.1097/00007632-197806000-00017. [DOI] [PubMed] [Google Scholar]
  • 23.Ford MJ, Martynoga AG, Nuki G. Iliopsoas bursitis in rheumatoid arthritis: an unusual cause of leg oedema. BMJ. 1981;282:947–948. doi: 10.1136/bmj.282.6268.947. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.Fritz P, Mariethe X, Clerc D, Glon Y, Bennet P, Bisson M. Rectus femoris sheath: a new localisation of hip synovial cyst. J Rheumatol. 1989;16:1575–1578. [PubMed] [Google Scholar]
  • 25.Garcia J, Chevalley P. Kystes synoviaux de la hanche: diagnostic par tomodensitométrie. J Radiol. 1985;66:425–432. [PubMed] [Google Scholar]
  • 26.Gatch WD, Green WT. Cysts of the ilio-psoas bursa. Ann Surg. 1925;82:277–285. doi: 10.1097/00000658-192508000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27.Generini S, Matucci-Cerinic M. Iliopsoas bursitis in rheumatoid arthritis. Clin Exp Rheumatol. 1993;11:549–551. [PubMed] [Google Scholar]
  • 28.Ginai Z. Synovial (osteo) chondromatosis of left hip joint and iliopsoas bursa. Skeletal Radiol. 1990;19:227–231. doi: 10.1007/BF00204106. [DOI] [PubMed] [Google Scholar]
  • 29.Goupille P, Anger C, Burdin P, Valat J-P. Iliopsoas bursitis. J Rheumatol. 1990;17:1566–1567. [PubMed] [Google Scholar]
  • 30.Gresser J, Bitz K, Binswanger R, Hegglin J. Bursitis ileopectinea — eine seltene Differentialdiagnose der schmerzhaften inguinalen Schwellung. Helv Chir Acta. 1992;59:383–388. [PubMed] [Google Scholar]
  • 31.Grindulis KA. Rheumatoid iliopsoas bursitis. J Rheumatol. 1986;13:988. [PubMed] [Google Scholar]
  • 32.Grindulis KA, McConkey B, Norcross K. Iliopsoas bursitis — a surgically correctable cause of lower limb oedema. Practitioner. 1982;226:1336–1337. [PubMed] [Google Scholar]
  • 33.Harper MC, Schaberg JE, Allen WC. Primary iliopsoas bursography in the diagnosis of disorders of the hip. Clin Orthop. 1987;221:238–241. [PubMed] [Google Scholar]
  • 34.Helfgott SM. Unusual features of iliopsoas bursitis. Arthritis Rheum. 1988;31:1331–1332. doi: 10.1002/art.1780311021. [DOI] [PubMed] [Google Scholar]
  • 35.Howie DW, Cain CMJ, Cornish BL. Pseudo-abscess of the psoas bursa in failed double-cup arthroplasty of the hip. J Bone Joint Surg [Br] 1991;73:29–32. doi: 10.1302/0301-620X.73B1.1991769. [DOI] [PubMed] [Google Scholar]
  • 36.Hucherson DC, Denman FR. Non-infectious iliopectineal bursitis. Am J Surg. 1946;72:576–579. doi: 10.1016/0002-9610(46)90394-7. [DOI] [PubMed] [Google Scholar]
  • 37.Jacobs P, Goei The HS, Bijlsma A, Versteege CW. Rheumatoid synovial cyst of the hip. Arthritis Rheum. 1983;26:814–815. doi: 10.1002/art.1780260625. [DOI] [PubMed] [Google Scholar]
  • 38.Jaffray DC, Nade S. Painless groin swelling associated with osteoarthritis of the hip. J R Coll Surg Edinb. 1986;31:185–186. [PubMed] [Google Scholar]
  • 39.Janus C, Hermann G. Enlargement of the iliopsoas bursa: an unusual cause of cystic mass on pelvic sonogram. J Clin Ultrasound. 1982;10:133–135. doi: 10.1002/jcu.1870100310. [DOI] [PubMed] [Google Scholar]
  • 40.Jensen MC, Brandt-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med. 1984;331:69–73. doi: 10.1056/NEJM199407143310201. [DOI] [PubMed] [Google Scholar]
  • 41.Jones PB, Economou G, Adams JE, Bernstein RM. Iliopsoas bursa presenting as deep vein thrombosis in rheumatoid arthritis. Br J Rheumatol. 1993;32:832–834. doi: 10.1093/rheumatology/32.9.832. [DOI] [PubMed] [Google Scholar]
  • 42.Kataoka M, Torisu T, Nakamura M, Uchida K. Iliopsoas bursa of the rheumatoid hip joint. A case report and review of the literature. Clin Rheumatol. 1995;14:358–364. doi: 10.1007/BF02208355. [DOI] [PubMed] [Google Scholar]
  • 43.Keller C, Leden I, Lidgren L, Stenberg T. Anaerobic bacterial coxitis and pseudocystic tumour in rheumatoid arthritis. Scand J Rheumatol. 1980;9:216–220. doi: 10.3109/03009748009112350. [DOI] [PubMed] [Google Scholar]
  • 44.Kolmert L, Persson BM, Herrlin K, Ekelund L. Iliopectineal bursitis following total hip replacement. Acta Orthop Scand. 1984;55:63–65. doi: 10.3109/17453678408992314. [DOI] [PubMed] [Google Scholar]
  • 45.Kummer E, Senarcleus P. Un cas d'hygroma chronique de la bourse du psoas-iliaque ou iliopectinée. Rev Med Suisse Rom. 1917;37:574–580. [Google Scholar]
  • 46.Lavyne MH, Voorhies RM, Coll RH. Femoral neuropathy caused by an iliopsoas bursal cyst. Case report. J Neurosurg. 1982;56:584–586. doi: 10.3171/jns.1982.56.4.0584. [DOI] [PubMed] [Google Scholar]
  • 47.Lazarevic MB, Skosey JL, Vitic J, Mladenovic V, Myones BL, Popovic J, Swedler WI. Cholesterol crystals in synovial and bursal fluid. Semin Arthritis Rheum. 1993;23:99–103. doi: 10.1016/s0049-0172(05)80016-2. [DOI] [PubMed] [Google Scholar]
  • 48.Leconte PH, Bastien J. Kyste synovial avec nécrose idiopathique de la tête fémorale. Rev Chir Orthop. 1979;65:353–355. [PubMed] [Google Scholar]
  • 49.Leekam RN, Matzinger MA, Mustard RA, Grosman H. Enlarged iliopsoas bursa simulating neoplasm on sonographic examination. J Ultrasound Med. 1985;4:493–494. doi: 10.7863/jum.1985.4.9.493. [DOI] [PubMed] [Google Scholar]
  • 50.Lequesne M, Damg N, Montagne P, Lemoine A, Witvoet J. Le conflit psoas-prothèse totale de hanche. Rev Rhum. 1991;58:559–564. [PubMed] [Google Scholar]
  • 51.Létourneau L, Dessureault M, Carette S. Rheumatoid iliopsoas bursitis presenting as unilateral femoral nerve palsy. J Rheumatol. 1991;18:462–463. [PubMed] [Google Scholar]
  • 52.Levy RN, Hermann G, Haimov M, Sherry HS, Train JS, Davison S. Rheumatoid synovial cyst of the hip. Arthritis Rheum. 1982;25:1382–1384. doi: 10.1002/art.1780251118. [DOI] [PubMed] [Google Scholar]
  • 53.Lupetin AR, Daffner RH. Rheumatoid iliopsoas bursitis: MR findings. J Comput Assist Tomogr. 1990;14:1035–1036. doi: 10.1097/00004728-199011000-00040. [DOI] [PubMed] [Google Scholar]
  • 54.Maneddu CA, Hoogewoud HM, Balague F, Waldeburger M. Infective iliopsoas bursitis — a case report. Int Orthopaedics. 1991;15:135–137. doi: 10.1007/BF00179712. [DOI] [PubMed] [Google Scholar]
  • 55.Matsumoto K, Hukuda S, Nishioka J, Fujita T. Iliopsoas bursal distension caused by acetabular loosening after total hip arthroplasty. A rare complication of total hip arthroplasty. Clin Orthop. 1992;279:144–148. [PubMed] [Google Scholar]
  • 56.McCarty DJ. Calcium pyrophosphate dihydrate crystal deposition disease. In: Schumacher HR, editor. Primer on the rheumatic diseases. Atlanta: Arthritis Foundation; 1988. pp. 207–210. [Google Scholar]
  • 57.Meaney JF, Cassar-Pullicino VN, Etherington R, Ritchie DA, McCall IW, Whitehouse GH. Iliopsoas bursa enlargement. Clin Radiol. 1992;45:161–168. doi: 10.1016/s0009-9260(05)80632-4. [DOI] [PubMed] [Google Scholar]
  • 58.Melamed A, Bauer CA, Johnson JH. Iliopsoas bursal extension of arthritic disease of the hip. Radiology. 1967;89:54–58. doi: 10.1148/89.1.54. [DOI] [PubMed] [Google Scholar]
  • 59.O'Connor DS. Early recognition of iliopectineal bursitis. Surg Gynecol Obstet. 1933;57:674–684. [Google Scholar]
  • 60.Pellman E, Kumari S, Greenwald R. Rheumatoid iliopsoas bursitis presenting as unilateral leg edema. J Rheumatol. 1986;13:197–200. [PubMed] [Google Scholar]
  • 61.Peters A, Tillmann B. Bursa iliopectinea — size and morphology. Anat Anz. 1988;167:403–407. [PubMed] [Google Scholar]
  • 62.Roman-Ivorra JA, Battle-Gualda E, Carro-Martinez AV. Iliopsoas bursitis as a cause of inguinal tumor formation. Rev Clin Esp. 1991;188:490–491. [PubMed] [Google Scholar]
  • 63.Samuelson C, Ward JR, Albo D. Rheumatoid synovial cyst of the hip: a case report. Arthritis Rheum. 1971;14:105–108. doi: 10.1002/art.1780140113. [DOI] [PubMed] [Google Scholar]
  • 64.Sartoris DJ, Danzig L, Gilula L, Greenway G, Resnick D. Synovial cysts of the hip joint and iliopsoas bursitis: a spectrum of imaging abnormalities. Skeletal Radiol. 1985;14:85–94. doi: 10.1007/BF00349741. [DOI] [PubMed] [Google Scholar]
  • 65.Savarese RP, Kaplan SM, Calligaro KD, DeLaurentis DA. Iliopectineal bursitis: An unusual cause of iliofemoral vein compression. J Vase Surg. 1991;13:725–727. [PubMed] [Google Scholar]
  • 66.Savy JM. Kystes synoviaux et bursites de hanche. Ann Radiol. 1993;36:52–57. [PubMed] [Google Scholar]
  • 67.Steinbach LS, Schneider R, Goldman AB, Kazam E, Ranawat CS, Ghelman B. Bursae and abscess cavities communicating with the hip: diagnosis using arthrography and CT. Radiology. 1985;156:303–307. doi: 10.1148/radiology.156.2.4011891. [DOI] [PubMed] [Google Scholar]
  • 68.Stephens VR. Cystic tumor of the iliopectineal bursa. Report of two cases. Arch Surg. 1944;49:9–11. [Google Scholar]
  • 69.Sumanovac Z. Traumatic cyst in the hip joint. J Bone Joint Surg [Am] 1959;41:175–178. [PubMed] [Google Scholar]
  • 70.Toohey AK, LaSalle TL, Martinez S, Polisson RP. Iliopsoas bursitis: clinical features, radiographic findings, and disease associations. Semin Arthritis Rheum. 1990;36:41–47. doi: 10.1016/0049-0172(90)90093-u. [DOI] [PubMed] [Google Scholar]
  • 71.Torisu T, Chosa H, Kitano M. Rheumatoid synovial cyst of the hip joint: a case report. Clin Orthop. 1978;137:191–194. [PubMed] [Google Scholar]
  • 72.Underwood PL, McLoed RA, Ginsburg WW. The varied clinical manifestation of iliopsoas bursitis. J Rheumatol. 1988;15:1683–1685. [PubMed] [Google Scholar]
  • 73.Watson JD, Ochsner SF. Compression of the bladder due to rheumatoid cysts of hip joint. Am J Roentgenol. 1967;99:695–696. doi: 10.2214/ajr.99.3.695. [DOI] [PubMed] [Google Scholar]
  • 74.Weinreb JC, Cohen JM, Maravilla KR. Iliopsoas muscles: MR study of normal anatomy and disease. Radiology. 1985;156:435–440. doi: 10.1148/radiology.156.2.4011906. [DOI] [PubMed] [Google Scholar]
  • 75.Weisser JR, Robinson DW. Pigmented villonodular synovitis of iliopectineal bursa. A case report. J Bone Joint Surg [Am] 1951;33:988–992. [PubMed] [Google Scholar]
  • 76.Wiesel SW, Tsourmas N, Feffer HL, Citrin CH, Patronas NA. A study of computer assisted tomography. The incidence of positive CAT-scans in an asymptomatic group of patients. Spine. 1984;9:545–551. [PubMed] [Google Scholar]
  • 77.Wilkinson L, Palmer R. Bilateral iliopsoas bursitis in rheumatoid arthritis. Br J Rheumatol. 1991;30:68–69. doi: 10.1093/rheumatology/30.1.68-a. [DOI] [PubMed] [Google Scholar]
  • 78.Williams RA, Marks LJ. Synovial cyst causing an inguinal mass. BMJ. 1978;2:91–92. doi: 10.1136/bmj.2.6130.91-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 79.Wossman W, Verhage CC. Enlarged iliopsoas bursa. A rare cause of inguinal mass. Tidsskr Nor Laegeforen. 1992;112:202–203. [PubMed] [Google Scholar]
  • 80.Yang SS, Bronson MJ. Cystic enlargement of the iliopsoas bursa causing venous obstruction as a complication of total hip arthroplasty. A case report. J Arthroplasty. 1993;8:657–661. doi: 10.1016/0883-5403(93)90015-v. [DOI] [PubMed] [Google Scholar]

Articles from European Spine Journal are provided here courtesy of Springer-Verlag

RESOURCES