PMC8343858_01
(a) Preoperative SPECT-CT after removing of metal artefacts. There is no visible tracer uptake in hip region. (b) Soft tissue reconstruction showing visible bursa with a comparable size to acetabular cup.
SPECT-CT: Single-photon emission computed tomography-computed tomography.
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On the images of the SPECT-CT, no accumulation of the isotopes was found and the bone cement mantle was intact (Figure 1).
(a) Preoperative ultrasound test, longitudinal view. Occluded vein is marked above the cyst. (b) Preoperative ultrasound test, the cross-section of the inguinal area showing a visible contact between structures.
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Tochigi, Japan) targeting the cystic mass. The imaging examinations confirmed our diagnosis, showing a direct contact of the iliopectineal bursa and femoral vein (Figure 2). 
Anterior approach of the hip. The cystic mass starts between ventral pseudo-capsule and iliopsoas muscle.
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Two incisions were made with special care to the width of the skin bridge between them; the medial end of the bursa was managed through a classical incision for reaching the neurovascular bundle; for the lateral end and to reach the joint, we used the anterior approach of the hip (Figure 3 and 4).
Approach for the neurovascular bundle. Forceps, being upper on the picture (closer to the midline in reality), holds vessels, lower forceps grasp wall of the bursa.
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Two incisions were made with special care to the width of the skin bridge between them; the medial end of the bursa was managed through a classical incision for reaching the neurovascular bundle; for the lateral end and to reach the joint, we used the anterior approach of the hip (Figure 3 and 4).
Approach for the neurovascular bundle. Green arrows indicate the contact between bursa and vessels. The bursa is filled with methylene blue.
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The contact with the vein was easy to detect (Figure 5).