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Osteitis pubis

Osteitis pubis is characterised by non-infectious inflammation of the pubic symphysis

Clinical presentation

Presentation is typically with varying degrees of lower abdominal and pelvic pain. 

Pathophysiology

Although the aetiology is sometimes unknown, the commonest causes are:

  • pregnancy / childbirth 2
  • high-level of athletic activity
  • urological or gynaecological surgery 2
  • trauma
  • psoriatic arthritis

Radiographic features

Plain film

The x-ray findings are subchondral erosive change, joint irregularity and sclerosis, which may eventually lead to ankylosis. Positive findings usually are not apparent until 4 weeks after the onset of symptoms

MRI

MRI may demonstrate parasymphyseal bone marrow oedema although this finding may also be seen in asymptomatic individuals. Symphyseal fluid and peripubic soft-tissue oedema during initial stages may also bee seen 1.

Nuclear medicine

Bone scans may be negative but can demonstrate intense signal uptake at the pubis symphysis.

Treatment and prognosis

Treatment is symptomatic and mainly relies upon rest. 

Differential diagnosis

The main differential diagnoses are infection and hyperparathyroidism, the latter due to bone resorption. On MRI, the initial stages of osteitis pubis may mimic osteomyelitis 1.

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