Prepatellar Bursitis Of The Knee

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Prepatellar Bursitis Of The Knee

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: 71 yo male presents with right anterior knee pain and swelling after a fall onto the right knee 2 months ago. Right knee pain is aggravated by kneeling. Exam shows a circular subcutaneous fluctuant fluid collection over the patella measuring 6 cm in diameter without redness, warmth to touch or drainage. There is 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 are normal. Type of Probe Used: 4-18 MHz linear array transducer Labeled Short Axis View of Right Proximal Patellar Tendon Short Axis view of Right proximal patellar tendon showing large complex fluid within the prepatellar bursa with bursal lining hypertrophy at the base. Unlabeled Long Axis View of Right Distal Patellar Tendon Long axis view of distal patellar tendon with overlying bursal distension Labeled Long Axis View of Right Distal Patellar Tendon Long axis view of right 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 Unlabeled Short Axis View of Right Proximal Patellar Tendon Short Axis view of proximal patellar tendon with overlying prepatellar bursal distension. Labeled Long Axis View Right Proximal Patellar Tendon Long Axis view of Right Proximal Patellar tendon with large complex fluid within the prepatellar bursa with bursal lining hypertrophy. Patellar tendon is intact. Labeled Long Axis View Right Patella Long Axis view of Right Patella with overlying prepatellar bursal distension/bursitis. No fractures or cortical irregularities along patella. Unlabeled Long Axis View Right Proximal Patellar Tendon Long Axis view of Right Proximal Patellar tendon with overlying prepatellar bursal distension Unlabeled Long Axis View Right Patella Long Axis view of Right Patella with overlying prepatellar bursal distension. Interpretation Image Interpretation: A large bursa distension overlying the patella and infrapatellar region with bursal lining hypertrophy at the base, complex fluid within the bursa characterized by central hyperechoic linear echoes and septations. The patellar tendon is intact. Teaching Pearl: There are three distinct bursa in the anterior knee: pre-patellar, superficial infrapatellar and deep infrapatellar. This case demonstrates extension of the bursal fluid collection inferiorly over the patellar tendon while classic prepatellar bursitis is typically visualized over the patella itself. Depending on the mechanism of injury and positional factors, the fluid can collect in a more dependent position with gravity. This necessitates close examination of the bursal planes to ascertain the primary source of the fluid. Other common causes of bursitis include infection, gout, and rheumatological causes. The largely distended prepatellar bursa was hemorrhagic in nature, consistent with its appearance: largely anechoic fluid with central/internal linear echoes and bursal lining hypertrophy. Clinically, chronic prepatellar bursitis presents as fluctuant, non-tender fluid accumulation over or below the patella. Point of care ultrasound of the anterior knee can help distinguish the affected bursa, as on gross examination, they may appear similar. Light pressure should be used with the transducer as to not collapse small amounts of fluid within a bursa.
NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.

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Authors, Editors, Case Information

Labeled Short Axis View of Right Proximal Patellar Tendon

Unlabeled Long Axis View of Right Distal Patellar Tendon

Labeled Long Axis View of Right Distal Patellar Tendon

Unlabeled Short Axis View of Right Proximal Patellar Tendon

Labeled Long Axis View Right Proximal Patellar Tendon

Labeled Long Axis View Right Patella

Unlabeled Long Axis View Right Proximal Patellar Tendon

Unlabeled Long Axis View Right Patella

Interpretation

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