What's the Diagnosis - Case 35

History 14y/o with several months of hip pain questionably related to sports.

What’s the Diagnosis - Case 35

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Findings Radiographs demonstrate asymmetry in the anterior superior iliac spines with irregularity particularly noted on the right side. On the IR MR images, there is edema in the subiliacus muscle and subiliacus bursitis. Additionally, seen is edema at the level of the anterior inferior iliac spine (AIIS) apophysis and a small avulsed bone fragment. On the proton density image, noted is prominent asymmetry of the right compared to left AIIS related to acute on chronic injury at the apophysis. Other areas of increased signal on the IR sequence are related to technique.

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Diagnosis: AIIS avulsion and posttraumatic subiliacus bursitis Avulsion injuries at the apophyses are common in the athletic, skeletally immature patient. As the apophyseal plate is less able to sustain load than tendons, the apophyseal plate tends to be the site of failure in the skelletally immature patient. In the pelvis, multiple apophyses are present particularly with injury often seen at the AIIS, anterior superior iliac spine, ischial tuberosity, and lesser trochanter. Although not discussed in the literature, anecdotally reported are avulsion injuries of the subiliacus muscle yielding posttraumatic bursitis in the skeletally immature patient. This may be similar to abdominal and gluteal muscle injuries sustained at the iliac crest in the skeletally mature patient.

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What’s the Diagnosis - Case 35

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