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Musculoskeletal and Sports Medicine

Olecranon Bursitis in a Heart Transplant Recipient with End-Stage Renal Disease: A Case Report

Saturday, October 25, 2025
8:00 AM - 9:15 AM MT
Location: Kiosk 2
Disclosure(s):
Ramnik S. Gill, Other: No financial relationships to disclose
Kahsavyah Buckley, M.Sc.: No financial relationships to disclose
Prathap Jayaram, MD: No financial relationships to disclose
Case Diagnosis: 67-year-old male with olecranon bursitis.

Case Description or Program Description: A 67-year-old male with a history of a heart transplant, end-stage renal disease, and atrial flutter presented to the clinic with left elbow swelling and pain that began after a left arm fistula revision 5 months prior. He denied IV drug use, trauma, weight loss, or recurrent fevers. On exam, the patient demonstrated a fluctuant yet firm, spherical mass approximately 5 cm in diameter over the left olecranon with mild calor and tenderness to palpation but no erythema. His anterior arm demonstrated a healed incision over the left distal bicep from his prior fistula surgery. His elbow ROM was slightly reduced with 10 degrees of extension and 130 degrees of flexion.

Setting: Outpatient Orthopaedic Clinic

Assessment/Results: Diagnostic Ultrasound demonstrated a large hypoechoic mass consistent with a resolving hematoma, fatty infiltration, and a small surrounding hyperechoic effusion. Aspiration with an 18-gauge needle was unsuccessful. The patient was encouraged to follow-up for repeat imaging and referred to orthopedic surgery for possible resection. However, given his complex medical history, the patient was recommended to continue with conservative treatment.

Discussion (relevance): While olecranon bursitis has been reported in patients on long-term hemodialysis, this case highlights a hematoma that interestingly formed after surgical revision of an arteriovenous fistula. This pathology was potentially caused by perioperative trauma to the olecranon either during bed transfer, surgical manipulation, or the post-op recovery period. Had the patient sought care for this issue acutely, the bursa may have been easier to aspirate without the chronicity seen in this case.

Conclusions: This unique case of olecranon bursitis reflects the challenges of surgical management of musculoskeletal conditions in patients with complex medical histories and the importance of early intervention to prevent long-term challenges to conservative care.