Femoral neuropathy caused by enlarged iliopsoas bursa associated with osteonecrosis of femoral head--a case report

Copyright © Taylor & Francis 2000. ISSN 0001–6470. Printed in Sweden – all rights reserved. A 56-year-old man had had weakness of the right leg and pain in the right hip for 4 months. He limped and also complained of paresthesia along the anterior distal thigh. Physical examination revealed marked limitation of motion of the right hip, atrophy of the right thigh and a 4–6 cm soft tissue mass in the inguinal area. Strength of the right quadriceps muscle was fair and the knee jerk was diminished. He was a heavy smoker and alcoholic. He had no history of steroid use. The conventional laboratory data including complete blood cell count, urine analysis and liver function tests were normal. Laboratory examinations for coagulopathy and for hypofibrinolysis were also normal. Electromyography revealed neuropathy of the right femoral nerve. Plain radiographs disclosed diffuse mottled sclerotic changes of the right femoral head and narrowing of the joint space (Figure 1). MRI showed abnormal signal intensities in the anterosuperior regions of the right femoral head consistent with avascular necrosis. An enlarged iliopsoas bursa with fluid collection which communicated with the hip joint was found (Figure 2). Contrast medium, when injected into the cyst, filled the enlarged iliopsoas bursa and hip joint,