Imaging Characteristics of Bursitis

Radiographic Findings

Soft tissue swelling may be visible as the only radiographic finding in early bursitis, though this is nonspecific 1
Calcifications within or around the bursa can be seen in chronic calcific bursitis, appearing as radio-opaque deposits adjacent to bony prominences 2, 3
Effacement of normal fat planes adjacent to the affected bursa may occasionally be detected 1
Associated joint space narrowing or osteoarthritis may be present when bursitis is secondary to degenerative joint disease 2, 3
Bone erosions or proliferation can occur in chronic inflammatory bursitis, but these represent the underlying disease rather than the bursitis itself 2
Soft tissue gas would only be visible in the rare case of septic bursitis with gas-forming organisms 4

The American College of Radiology recommends that radiographs should still be obtained first to exclude other causes of pain, but they are inadequate for diagnosing bursitis itself 5, 3
Ultrasound is the preferred next imaging modality for suspected bursitis due to its superior ability to visualize bursal fluid, thickening, and inflammation 5
Ultrasound can reliably detect bursal collections, capsular and bursal thickening, and synovitis, and allows dynamic assessment and can guide therapeutic injections in the same session 5
MRI should be reserved for cases where ultrasound is equivocal, deeper structures need evaluation, or associated pathology is suspected 5, 3
Normal radiographs do not exclude bursitis and should prompt ultrasound evaluation when clinical suspicion remains high 5