Ischiopubic synchondrosis asymmetry
Updates to Article Attributes
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.
Epidemiology
Occurs in all children before puberty during fusion of the pubic and ischial bones 3.
Clinical presentation
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.
Pathology
Ischiopubic synchondrosis asymmetry is much more common onIn younger children the side ofischio-pubic synchondroses are symmetrically enlarged. Prior to fusion, enlargement may persist in the non-dominant leg due to greater mechanical stress. For example, in footballers, mechanical stresses are greater in the weight-bearing non-dominant foot, withleg compared to the differenceskicking leg. This causes a stress reaction in ossification thoughtthe synchondrosis. Similarly, preferential weight-bearing can cause asymmetrical enlargement contralateral to result from asymmetric mechanical forces unilateral painful hip conditions3.
Radiographic features
Recognition of an entity as a normal variant is important for radiologists when interpreting a paediatric 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.
Differential diagnosis
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.
-<p><strong>Ischiopubic synchondrosis asymmetry</strong> (also known as <strong>van Neck-Odelberg disease)</strong> is characteristic enlargement of one of the ischiopubic synchondroses. It is largely considered an <a href="/articles/anatomical-variants">anatomic variant</a> of skeletal developmental, given that it is a common and usually asymptomatic finding.</p><p>However, some cases are thought to be symptomatic and may correspond to MR findings that suggest a stress reaction <sup>7,8</sup>.</p><h4>Epidemiology</h4><p>Occurs in all children before puberty during fusion of the pubic and ischial bones <sup>3</sup>.</p><h4>Clinical presentation</h4><p>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 <sup>7,8</sup>.</p><h4>Pathology</h4><p>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 <sup>3</sup>. </p><h4>Radiographic features</h4><p>Recognition of an entity as a normal variant is important for radiologists when interpreting a paediatric pelvic radiograph. One of the key questions to ascertain is whether the region is painful or not:</p><ul>- +<p><strong>Ischiopubic synchondrosis asymmetry</strong> (also known as <strong>van Neck-Odelberg disease)</strong> is characteristic enlargement of one of the ischiopubic synchondroses. It is largely considered an <a href="/articles/anatomical-variants">anatomic variant</a> of skeletal developmental, given that it is a common and usually asymptomatic finding.</p><p>However, some cases are thought to be symptomatic and may correspond to MR findings that suggest a stress reaction <sup>7,8</sup>.</p><h4>Epidemiology</h4><p>Occurs in all children before puberty during fusion of the pubic and ischial bones <sup>3</sup>. </p><h4>Clinical presentation</h4><p>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 <sup>7,8</sup>.</p><h4>Pathology</h4><p>In younger children the ischio-pubic synchondroses are symmetrically enlarged. Prior to fusion, enlargement may persist in the non-dominant leg due to greater mechanical stress. For example, in footballers, mechanical stresses are greater in the weight-bearing leg compared to the kicking leg. This causes a stress reaction in the synchondrosis. Similarly, preferential weight-bearing can cause asymmetrical enlargement contralateral to unilateral painful hip conditions<sup>3</sup>. </p><h4>Radiographic features</h4><p>Recognition of an entity as a normal variant is important for radiologists when interpreting a paediatric pelvic radiograph. One of the key questions to ascertain is whether the region is painful or not:</p><ul>
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