Injection granuloma

Case contributed by Omar M. Sultan
Diagnosis certain


Left iliac crest pain.

Patient Data

Age: 50 years
Gender: Female

There is some widening of anterior part of left iliac crest mostly suggestive of left iliac crest apophysitis.

Bilateral calcific nodular shadows are incidentally seen in pelvis AP view, lateral to both iliac bones, changed in orientation in oblique view and appear superficial in the lateral view in the region of buttock.

Case Discussion

Injection granulomas are one of the most common findings in the gluteal region. They can be single or multiple, unilateral or bilateral, and vary in size.

Post injection, fat necrosis and dystrophic calcification take place, resulting in calcified granulomas.

Subcutaneous (intra-fat) granuloma is much more common than intramuscular granuloma (93% vs 7%). This is due to the fact that buttock subcutaneous fat thickness (5.7 +/- 1.8 cm for female vs 4.4 +/- 1.7 cm for male) exceeds the length of the most commonly used needle for intramuscular buttock injection (3.8 cm).

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