Rationale and objectives <p>The iliopsoas bursa, collapsed in its normal state, provides a gliding surface between the hip joint and the iliopsoas musculotendinous complex. Its enlargement is generally non-symptomatic, but can cause pain, an inguinal mass or symptoms related to compression of neighboring structures. However, anatomical studies of this bursa are scarce. Thus, the aim of this study was to describe its morphology and relationship with adjacent structures on CT arthrography, specifically in cases where the bursa communicates with the hip joint.</p> Materials and methods <p>Consecutive hip CT arthrography examinations in which bursal effusion had been reported were retrospectively analyzed. The iliopsoas bursa was described according to its shape, size and relationship with neighboring structures. CT arthrograms were reviewed for the presence of spontaneous iliopsoas bursa opacification due to communication with the underlying hip joint.</p> Results <p>178 hip CT scans were reviewed. An enlarged medial arm in a deep intramuscular location, between the femoral neurovascular bundle medially and the iliopsoas tendon laterally, was always visible. The bursa was unilobed, with a “teardrop” shape in 2 examinations. The lateral arm was distended in 23 cases, with a unilobed or bilobed appearance, respectively presenting a “horseshoe” or “trident” shape. Communication between the hip joint space and the bursa was shown in 25 of the 178 hip CT arthrograms.</p> Conclusion <p>The iliopsoas bursa can be recognized by its close relationship with the iliopsoas tendon, which can divide it, resulting in a “teardrop”, “horseshoe” or “trident” shape in the axial plane.</p>