Osteitis condensans ilii

Osteitis condensans ilii is characterized by benign sclerosis of the ilium adjacent to the sacroiliac (SI) joint, typically bilateral and triangular in shape.

Clinical presentation

It is usually asymptomatic but uncommonly may cause lower back pain, with a frequency of about 1-2.5% ⁴.

Pathology

The underlying etiology is believed to be mechanical stress across the sacroiliac joint. That it is most often seen in women who have given birth supports this hypothesis; however, men and nulliparous women can be affected ^2-4. 

Radiographic features

Plain radiograph and CT

Sclerosis of the iliac side of the sacroiliac joint is seen, typically bilateral, symmetrical and triangular in shape ^3,4. Lack of sacral involvement or joint space narrowing is considered diagnostic and thus, may obviate the need for further imaging ³. Unilateral disease has been reported.

Treatment and prognosis

It carries a benign prognosis and may even resolve spontaneously. 

Differential diagnosis

The main differential diagnosis is a sacroiliitis, but with osteitis condensans ilii the SI joint itself is normal, with no irregularity, erosions, or loss of joint space.