A lump on the hip

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FIGURE 1
Left lateral hip 2 weeks after a fall.
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FIGURE 2
Ultrasonography with a curvilinear 2- to 5-MHz probe and a long-axis view revealed a superficial heterogeneous and hypoechoic area (asterisk) at the greater trochanter (GT).

TABLE 1

Differential diagnosis of a traumatic lateral hip lump

Condition	Cause	Diagnostic clues	Management
Hemorrhagic greater trochanter bursitis²	Usually from direct trauma; bursa is located deep and is small	Normal hip range of motion; a fluctuating mass over the greater trochanter may be palpable; ultrasonography (US) or magnetic resonance imaging (MRI) necessary for diagnosis	Conservative management often adequate; if bursal enlargement is significant, US-guided aspiration warranted
Greater trochanter fracture³	Typically from direct trauma	Patient may or may not be able to bear weight; hip range of motion and resisted abduction often produce pain; greater trochanter tenderness is significant; plain radiography needed for the diagnosis	Referral to an orthopedic surgeon is recommended; operative management required only with significant displacement
Intramuscular gluteus medius hematoma⁴	Usually from direct trauma; may be concurrent with hip fracture	Usually deep and not visible during the physical examination; US or MRI required for definitive diagnosis	Conservative management often adequate; in cases with significant enlarged hematoma, US-guided aspiration warranted
Morel-Lavallée lesion⁵	Usually from shearing trauma	MRI or US helpful for diagnosis	Depending on type and stage of lesion, options may include watchful waiting, compression, aspiration, injection of sclerosing agent, drainage, and incision and evacuation