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 |