Bursal lipohematoma: a CT sign of full thickness rotator cuff tear in patients with proximal humerus fractures

Emerg Radiol. 2019 Jun;26(3):257-262. doi: 10.1007/s10140-018-01666-9. Epub 2019 Jan 6.


Purpose: The main purpose of the study is to determine if the presence of a particular computed tomography (CT) imaging finding, a bursal lipohematoma, portends the presence of a concomitant rotator cuff tear (RCT) in patients with proximal humerus fractures by reviewing previous CTs.

Methods: Three hundred eighty-six CT scans were retrospectively reviewed by two board-certified radiologists to determine the presence of a proximal humerus fracture and to assess for the presence of a subacromial/subdeltoid or subcoracoid bursal hematoma. The medical record including operative documentation was then examined in the patients with proximal humerus fractures, with or without a concomitant bursal lipohematoma.

Results: Of the surgically managed patients, four had an intraoperative diagnosis of RCT. The preoperative CT scans of all of these patients demonstrated a bursal lipohematoma. Additionally, a non-surgically managed patient with a subacromial/subdeltoid bursal lipohematoma on CT scan was found to have a RCT on subsequent MRI. Of note, a rotator cuff tear was not documented in operative reports of patients with CT scans that were not found to contain a bursal lipohematoma.

Conclusions: Bursal lipohematoma is a potentially useful preoperative CT sign of full thickness rotator cuff tear in patients with proximal humerus fractures, providing the clinician with more information in the optimization of the management approach.

Keywords: Bursal lipohematoma; Fracture; Proximal humerus; Rotator cuff.

MeSH terms

  • Adult
  • Bursa, Synovial / diagnostic imaging*
  • Bursa, Synovial / injuries*
  • Bursa, Synovial / surgery
  • Diagnosis, Differential
  • Female
  • Hematoma / diagnostic imaging*
  • Hematoma / surgery
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Retrospective Studies
  • Rotator Cuff Injuries / diagnostic imaging*
  • Rotator Cuff Injuries / surgery
  • Shoulder Fractures / diagnostic imaging*
  • Shoulder Fractures / surgery
  • Tomography, X-Ray Computed / methods*