Labral Cysts Vs Iliopsoas Bursitis

[Iain Bell]

Hi Steve, all,
Any tips on distinguishing hip paralabral cyst from iliopsoas bursitis?
I’ve had a vague ‘probable’ paralabral cyst reported on US, but her presentation is more in keeping with iliopsoas pathology.
Cheers,
Iain

[Stephen Bird]

A paralabral cyst is essentially a ganglion and is non compressible and arrises from the labrum.
They usually sit anterior to the labrum adjacent the iliofemoral ligament in front of the femoral head.
They are rarely very large and behave like you would expect a ganglion to behave.

Iliopsoas bursitis is either fluid within a large bursa or synovial proliferation. Either way it is a more diffuse process. If it is bursitis with synovial proliferation only it can be subtle and you will see the iliopsoas tendon displaced from the bony iliopectineal eminence. This looks nothing like a labral cyst as it is a diffuse process in the bursa.

If the iliopsoas bursa communicates with the hip joint things get more difficult. There will be fluid within the bursa rather than just synovial proliferation and this can mimic a paralabral cyst, however the fluid is not hard like a ganglion and you can change the shape and position of the fluid with dynamic movements. Burial fluid is sometimes seen like a bakers cyst shape wrapping around the iliopsoas tendon. Bursal effusions can also become massive and any large fluid mass anterior to the hip joint is likely this rather than a para labral cyst.

Steve.

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