Bone marrow oedema (BME) is commonly found in hip MR imaging. BME is a nonspecific finding which can be related to a wide variety of diseases. However, there are cases where its existence or its pattern can narrow the differential or even point to a specific diagnosis. Therefore, deep understanding of its pathophysiology is of utmost importance for clinicians and radiologists in order to avoid diagnostic pitfalls. We hereby present currently established knowledge on BME related to adult hip pathology, aiming to raise physicians' suspicion and to highlight that it is mandatory to combine specific imaging patterns with the history, clinical and laboratory findings in order to achieve accurate diagnosis.