Pubic rami and tubercle fractures (DXA)

Case contributed by Kevin Banks
Diagnosis almost certain

Presentation

Follow-up treatment for osteoporosis.

Patient Data

Age: 80 years
Gender: Female

DXA

Nuclear medicine

Bone density scan (dual-energy X-ray absorptiometry) shows standard views of the lumbar spine and bilateral hips, along with regions of interest (ROIs). Applicable BMDs and T-scores are provided, with osteopenia present.

A review of the images shows irregularity of the left inferior pubic rami and pubic tubercle. The appearance suggests a healing callus related to subacute fractures.

The frontal view of the pelvis confirms the presence of healing fractures of the left inferior pubic rami and pubic tubercle.

Case Discussion

DXA images are of lower resolution than radiographs, but they are important to review by the technologist and physician for several reasons:

  • confirming appropriate patient positioning and placement of regions of interest in the lumbar spine, hips, and forearm (if assessed)

  • identifying overlying hardware, enteric contrast, soft tissue calcifications, or other densities that might lead to a spurious calculated bone mineral density (BMD)

  • detecting diseases of clinical importance that may or may not impact the BMD, such as bone metastases, fractures, or Paget's disease

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