Ischiopubic synchondrosis asymmetry (van Neck- Odelberg disease)

Case contributed by Subha Ashok
Diagnosis almost certain

Presentation

Complaint of hip and leg pain while sitting. No history of trauma/ fever.

Patient Data

Age: 13 years
Gender: Male
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Right ischio-pubic synchondrosis is not fused and appears mildly widened with irregular sclerotic margins. Adjacent soft tissue is normal. Left inferior pubic ramus is normal with fused ischio-pubic synchondrosis.

Case Discussion

Ischiopubic synchondrosis is the junction between the inferior ischial and pubic rami. The rate and pattern of mineralization and subsequent age of fusion are variable and usually asymmetric.  It is frequently seen in asymptomatic patients imaged for other reasons. Some children may present with pain in the hip, groin or gluteal region with restriction of movement or limping. 

On plain radiography, it is seen as a well marginated expansile lesion with osteopenia and patchy sclerosis. Computed Tomography is not commonly used to avoid unnecessary radiation exposure in pediatric patients, however, similar findings can be seen on CT.

On MRI, the lesion appears hyperintense on fat-suppressed T2 weighted and STIR images with hypointensity on T1 weighted images. These findings suggest hyperemia edema secondary to stress on the temporary joint.

Treatment is conservative with antiinflammatory therapy and rest.

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