Prepatellar Bursitis

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Prepatellar Bursitis

Authors, Editors, Case Information Author: Alexandre Mazar, MD Affiliation: Bassett Healthcare Network Co Author(s): Emma Cronk, M.D., CAQSM, Robert Gapinski, M.D.,CAQSM, RMSK. Clinical Vignette: A 71-year-old male presented with right anterior knee pain and swelling after a fall onto the right knee 2 months prior. Right knee pain was aggravated by kneeling. Exam showed a circular subcutaneous fluctuant fluid collection over the patella measuring 6 cm in diameter without redness, warmth to touch or drainage. There was mild tenderness to palpation of the fluid collection but no tenderness to palpation of the medial or lateral joint lines. Range of motion and strength of the right knee were normal. Type of Probe Used: 4-18 MHz linear array transducer Unlabeled Long Axis View of the Right Pre-Patellar Bursa Unlabeled Long Axis View of the Right Pre-Patellar Bursa Labeled Long Axis View of the Right Pre-Patellar Bursa Labeled Long Axis View of the Right Pre-Patellar Bursa with prepatellar bursal distension/bursitis. No fractures or cortical irregularities along patella. Unlabeled Long Axis View of the Right Proximal Patellar Tendon Unlabeled Long Axis View of the Right Proximal Patellar Tendon with overlying prepatellar bursal distension Labeled Long Axis View of the Right Proximal Patellar Tendon Labeled Long Axis View of the Right Proximal Patellar Tendon with large complex fluid within the prepatellar bursa with bursal lining hypertrophy. Patellar tendon is intact. Unlabeled Short Axis View of the Right Proximal Patellar Tendon Unlabeled Short Axis View of the Right Proximal Patellar Tendon with overlying prepatellar bursal distension. Labeled Short Axis View of the Right Proximal Patellar Tendon Labeled Short Axis View of the Right Proximal Patellar Tendon showing large complex fluid within the prepatellar bursa with bursal lining hypertrophy at the base. Unlabeled Long Axis View of the Distal Patellar Tendon Unlabeled Long Axis View of the Distal Patellar Tendon with overlying bursal distension Labeled Long Axis View of the Distal Patellar Tendon Labeled Long Axis View of the Distal Patellar Tendon. There is partial visualization of a distended prepatellar bursa with complex fluid. Distal Patellar tendon is intact. There is no superficial or deep infrapatellar bursal distension/bursitis Interpretation Image Interpretation: A large hypoechoic bursal distension is appreciated overlying the patella and infrapatellar region with hypertrophy of the bursal lining at the base, complex fluid within the bursa characterized by central hyperechoic linear echoes and septations. The patellar tendon is intact. Teaching Pearl: The anterior knee contains distinct superficial and deep bursae, and ultrasound can help differentiate prepatellar bursitis from superficial infrapatellar bursitis, deep infrapatellar bursopathy, cellulitis, joint effusion, and patellar tendon pathology. Prepatellar bursitis appears as fluid superficial to the patella and may extend inferiorly over the patellar tendon. Complex fluid, septations, synovial thickening, and Doppler hyperemia can be seen in inflammatory, chronic, hemorrhagic, or infectious bursitis. If the bursa is warm, erythematous, markedly tender, or associated with systemic symptoms, septic bursitis should remain on the differential. References: 1. Draghi F, Corti R, Urciuoli L, Alessandrino F, Rotondo A. Knee bursitis: a sonographic evaluation. J Ultrasound. 2015;18(3):251-257. doi:10.1007/s40477-015-0168-z 2. Flores DV, Mejia Gomez C, Pathria MN. Layered approach to the anterior knee: normal anatomy and disorders associated with anterior knee pain. Radiographics. 2018;38(7):2069-2101. doi:10.1148/rg.2018180048 3. Baumbach SF, Lobo CM, Badyine I, Mutschler W, Kanz KG. Prepatellar and olecranon bursitis: literature review and development of a treatment algorithm. Arch Orthop Trauma Surg. 2014;134(3):359-370. doi:10.1007/s00402-013-1882-7
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Authors, Editors, Case Information

Unlabeled Long Axis View of the Right Pre-Patellar Bursa

Labeled Long Axis View of the Right Pre-Patellar Bursa

Unlabeled Long Axis View of the Right Proximal Patellar Tendon

Labeled Long Axis View of the Right Proximal Patellar Tendon

Unlabeled Short Axis View of the Right Proximal Patellar Tendon

Labeled Short Axis View of the Right Proximal Patellar Tendon

Unlabeled Long Axis View of the Distal Patellar Tendon

Labeled Long Axis View of the Distal Patellar Tendon

Interpretation

UPCOMING EVENTS

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