Ischiopubic synchondrosis asymmetry (also known as van Neck-Odelberg disease) is characteristic enlargement of one of the ischiopubic synchondroses. It is largely considered an anatomic variant of skeletal developmental, given that it is a common and usually asymptomatic finding.
However, some cases are thought to be symptomatic and may correspond to MR findings that suggest a stress reaction 7,8.
Occurs in all children before puberty during fusion of the pubic and ischial bones 3.
Most cases of ischiopubic synchondrosis asymmetry are observed in asymptomatic patients. Symptomatic cases are described as presenting with groin or buttock pain in ambulatory, pre-pubertal children 7,8
Ischiopubic synchondrosis asymmetry is much more common on the side of the weight-bearing non-dominant foot, with the differences in ossification thought to result from asymmetric mechanical forces 3.
Recognition of an entity as a normal variant is important for radiologists when interpreting a pediatric pelvic radiograph. One of the key questions to ascertain is whether the region is painful or not:
- if asymptomatic and there is no concerning antecedent history: it is unlikely to represent a sinister pathology other than just a developmental variant
- if symptomatic or if the there is concerning antecedent history: it could still be a developmental variant although other important differential considerations should also be considered
Ischiopubic synchondrosis can be avid on bone scintigraphy 10 and FDG PET/CT.
On imaging alone, the condition can mimic many other pathological entities including:
The preceding clinical history is crucial in image interpretation.
History and etymology
The condition is named after M van Neck and A Odelberg who initially described these findings in 1924 4,5.
- 1. Macarini L, Lallo T, Milillo P et-al. Case report: Multimodality imaging of van Neck-Odelberg disease. Indian J Radiol Imaging. 2011;21 (2): 107-10. Indian J Radiol Imaging (full text) - doi:10.4103/0971-3026.82286 - Free text at pubmed - Pubmed citation
- 2. Kozlowski K, Hochberger O, Povysil B. Swollen ischiopubic synchondrosis: a dilemma for the radiologist. Australas Radiol. 1995;39 (3): 224-7. Pubmed citation
- 3. Herneth AM, Philipp MO, Pretterklieber ML et-al. Asymmetric closure of ischiopubic synchondrosis in pediatric patients: correlation with foot dominance. AJR Am J Roentgenol. 2004;182 (2): 361-5. AJR Am J Roentgenol (full text) - Pubmed citation
- 4. van Neck M. Osteochondrite du pubis. Arch Franco-Belg Chir 1924;27:238 –241
- 5. Odelberg A. Some cases of destruction in the ischium of doubtful etiology. Acta Chir Scand1924 ;56:273
- 6. Oliveira F. Differential diagnosis in painful ischiopubic synchondrosis (IPS): a case report. Iowa Orthop J. 2011;30: 195-200. Free text at pubmed - Pubmed citation
- 7. Wait A, Gaskill T, Sarwar Z et-al. Van neck disease: osteochondrosis of the ischiopubic synchondrosis. J Pediatr Orthop. 2011;31 (5): 520-4. doi:10.1097/BPO.0b013e31821f9040 - Pubmed citation
- 8. Herneth AM, Trattnig S, Bader TR et-al. MR imaging of the ischiopubic synchondrosis. Magn Reson Imaging. 2000;18 (5): 519-24. Pubmed citation
- 9. Kloiber R, Udjus K, McIntyre W et-al. The scintigraphic and radiographic appearance of the ischiopubic synchondroses in normal children and in osteomyelitis. Pediatr Radiol. 1988;18 (1): 57-61. Pubmed citation
- 10. Hardoff R, Gips S. Ischiopubic synchondrosis. Normal finding, increased pubic uptake on bone scintigraphy. (1992) Clinical nuclear medicine. 17 (2): 139. Pubmed