Clinical, ultrasonographic, and macroscopic findings of bursitis in cows were compared to assess the contribution of diagnosis and therapy planning. Sixteen dairy cows with swelling at the carpal (n = 12) or tarsal (n = 4) region were examined clinically and ultrasonographically and the findings were compared. In 10 patients the bursae were removed in toto. According to the duration of the disease (history) and clinical findings nine and seven patients had acute and chronic bursitis, respectively. Six had fluctuation and in 10 the bursa was firm. Contents were serous (n = 3), serotibrinous (n = 4), serohemorrhagic (n = 2), or purulent (n = 1). Sonographically there was fluid in all bursa except one. Capsule echogenicity varied between hypoechoic and hyperechoic and mean capsule thickness was 9.2 +/- 4.1 mm. Fourteen of the bursae contained free-floating particles. The hyperechoic capsules represented fibrous tissue, and the echogenic/hyperechoic free-floating particles were erythrocytes, purulent exudate, or fibrin masses. Capsule thickness and large free-floating particles could not be detected by clinical examination/centesis alone. However, capsule thickness, bursa contents, and the extent of inflammation could be determined ultrasonographically and this made the decision for different invasive/ operative procedures easier.