Issou case 67

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Resources

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Findings • A fluid intensity mass is present about the medial aspect of the right hip.

Following the mass on multiple images shows a connection to a more multloculated mass that emanates from the acetabular laburum/transverse acetabular ligament. There is a mild amount of edema in the adjacent adductor musculature and the mass is insinuated about and displaces the anterior and posterior branches of the obturator nerve.

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Diagnosis: Pedunculated paralabral cyst emanating from inferior labrum/transverse acetabular ligament •

Paralabral and parameniscal cysts are common processes of the shoulder and knee resectively and paralabral cysts are becoming increasingly better recognized in the hip. These can present as large fluid masses that need to be delineated from the multiple bursae that can occur around the hip.

Paralabral cysts, as in the shoulder, emanate from tearing or previous injury of the labrum as is seen in this case. The cysts themselves may cause pain from mass effect or by affecting adjacent neural structures as seen in this case. The edema of the addutor brevis in this case may be from direct mass effect of the cyst or from mass effect upon the branches of the obturator nerve. Symptomatic treatment can be rendered by ultrasound guided aspiration and steroid injection but often hip arthroscopy is required to address the underlying labral pathology.

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