Bilateral iliac bone stress fractures

Case contributed by Dr Nick Tarasov

Presentation

Bilateral buttock pain for 9 months.

Patient Data

Age: 35 years
Gender: Male

There is bilateral bone marrow edema within iliac bones seen on both T1 and T2 sequences with moderate periosteal reaction.

 A linear defect within the left iliac bone seen only on coronal images.

Also, note the left acetabulum roof defect with perifocal bone marrow edema.

Case Discussion

Sometimes it's hard to interpret imaging findings without a patient's history. Our patient (soldier) has had an extensive workout with no adequate training about 9 months ago. 

The most frequent site for stress fractures of the pelvic region is the lateral mass of the sacrum, pelvic stress fractures are rare - up to 7% of all stress fractures. There are few similar cases with bilateral iliac bones involvement published.

Therefore, MRI is unsurpassed tool for detecting bone marrow edema among athlets and military personnel because of low CT and radiography sensitivity.

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