Pitt pit lesion

Case contributed by Safwat Mohammad Almoghazy
Diagnosis almost certain


A known case of metastatic non-small cell lung cancer to brain.

Patient Data

Age: 55 years
Gender: Male

Apart from oval or round lucency noted in the anterosuperior aspect of the right femoral neck suggestive of Pitt pit lesion, no suspicious lesion in the visualized bones.

Average size liver with no convincing hepatic focal lesion.

Right adrenal gland enhancing lesion measuring about 2.5 x 1.5 cm suspicious of metastatic lesion.

The left adrenal gland, spleen, gallbladder, biliary tree, pancreas, kidneys, urinary bladder and prostate are unremarkable.

No sizable retroperitoneal, mesenteric, pelvic or inguinal lymph node. No overt peritoneal nodule or ascites.

Case Discussion

Pitt pit refers to an oval or round lucency in the anterosuperior aspect of the femoral neck, just distal to the articular surface. It represents a herniation of synovium or soft tissues into the bone through a cortical defect, hence the alternate name synovial herniation pit. They are usually around 5 mm in diameter but can be anywhere between 3 mm and 15 mm.

They are most often an incidental finding and of no clinical significance. There is debate about the exact etiology of herniation pits. There is some evidence that they may result from femoroacetabular impingement as around 30% of patients with this condition are found to have such a pit 2.  

Pitt pit is one of the skeletal ''do not touch'' lesions.

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