From the Research
Ultrasound can differentiate septic bursa from non-septic bursitis by evaluating specific imaging characteristics, such as bursal wall thickening, internal debris, and vascularity on Doppler imaging, as supported by studies like 1.
Key Imaging Characteristics
- Septic bursitis typically shows marked bursal wall thickening, often greater than 2mm, with hyperechoic internal debris and heterogeneous fluid collections containing floating echogenic material representing pus.
- The bursal wall frequently demonstrates increased vascularity on Doppler imaging, appearing as hyperemia surrounding the infected bursa.
- In contrast, non-septic bursitis usually presents with thinner walls, more homogeneous anechoic or hypoechoic fluid, and minimal to no internal echoes or debris.
Clinical Correlation
While ultrasound findings are helpful, they should be correlated with clinical presentation and laboratory findings, as definitive diagnosis of septic bursitis requires bursal fluid aspiration for cell count, Gram stain, and culture, as noted in studies like 2.
Pathophysiological Differences
These imaging differences reflect the underlying pathophysiology, with septic bursitis involving bacterial invasion causing intense inflammation, cellular debris accumulation, and vascular engorgement, while non-septic bursitis results from mechanical irritation or inflammatory conditions with less dramatic tissue reaction.
Management Considerations
The management of septic bursitis may involve empiric antibiotic therapy, as discussed in studies like 3, 4, and 5, highlighting the importance of early recognition and treatment to reduce morbidity and mortality.