This 13-year-old female cross country runner presents with left-sided anterolateral pain superior to the iliac crest. How many observations can you make from the first two images? Image 1 is a fat-weighted coronal T1 image and image 2 is a coronal proton-density image with fat suppression. Images 3 and 4 are the same images with the abnormalities labeled, but see what you can glean from the unlabeled images first.
Coronal T1
Coronal STIR
Coronal T1
Coronal STIR
The pink arrows point to iliac overuse syndrome/apophysitis bilaterally, even though the patient is only symptomatic on the left. Blue arrows point to osteitis pubis with swelling of the pubic capsule. Green arrows point to edema of the adjacent superior pubic ramus.
Some additional questions:
- What names might you use to describe the pubic abnormality radiographically and clinically?
- Athletic pubalgia and sports hernia syndrome are often lumped together in the same discussion. How might you segregate them based on imaging?
Answers:
- Radiographically, osteitis pubis; and clinically, athletic pubalgia
- Athletic pubalgia is centered in the pubic disc. Pubic disc injury and ligamentous microinstability involving the superior and inferior pubic ligaments as well as arcuate ligament lead to excess motion and edema of the adjacent bones, as is seen here. On the other hand, sports hernia refers to a collection of abnormalities that are primarily relegated to the soft tissues specifically and/or more characteristically:
- The rectus abdominus centrally
- The rectus abdominus laterally
- The prepubic plate
- The adductors and their origins
- Other nearby soft tissue structures
- For more case review, visit MRI Online.
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