A 21-year-old male with atraumatic right hip pain: diagnosis and discussion
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A 21-year-old male with atraumatic right hip pain: diagnosis and discussion Leon Sergot 1 & Sian Davies 1 & Paul Davison 1 & Julian Chakraverty 1
# ISS 2020
Test yourself: question A 21-year-old male with atraumatic right hip pain
History A 21-year-old male initially presented to his General Practitioner with atraumatic right hip and thigh pain. He was subsequently referred for MRI of the hip/pelvis by an orthopaedic surgeon.
Test yourself: answer A 21-year-old male with atraumatic right hip pain: diagnosis and discussion
Diagnosis Subperiosteal haematoma of the left iliac bone
Discussion Pelvic MRI revealed no right hip abnormality but an incidental lesion of the contralateral iliac bone: a superficial, partially cystic, lenticular lesion arising from the pelvic side of the left The case presentation can be found at https://doi.org/10.1007/s00256020-03460-6 * Leon Sergot [email protected] 1
Department of Radiology, University Hospitals Bristol NHS Trust, Marlborough Street, Bristol BS1 3NU, UK
iliac blade, underlying the iliacus muscle (Figs. 1, 2, 3, 4 and 5). There is a sclerotic border, no soft tissue component nor deep extension and no underlying bone marrow oedema. The sclerotic border and cystic component are appreciable on the radiograph (Fig. 6) but easily overlooked given the presence of overlying bowel gas. These appearances are consistent with a subperiosteal haematoma of the left iliac bone. The smooth-edged lentiform morphology strongly implies a subperiosteal location, as demonstrated in other anatomical locations such as the calvarium [1], caused by blood products expanding into a non-extendable space. In this case, the contralateral location to that of the symptoms suggests chronicity. This is corroborated by imaging characteristics suggestive of chronic blood products: the central component is low/isointense on T1 and high on T2 and peripheral component low signal on both. Here, the low intensity peripheral component is more likely explained by peripheral ossification, a well-recognized process in haematoma evolution. Old, subsequently ossified subperiosteal haematomata have been described to demonstrate a specific sign coined the ‘ghost cortex’ [2]: On CT and MRI, the ossified haematoma can be seen overlying but not obscuring the native (or ‘ghost’) cortex—best demonstrated on Fig. 2. More acute haematomata may demonstrate less ossification, and signal characteristics may also differ corresponding to the age of the blood products. Early phase lesions demonstrate callus formation in the absence of a fracture; it matures with ossification if the haematoma fails to resorb spontaneously [3, 4], as illustrated in this case. The loose attachment of the periosteum in adolescents results in susceptibility of traumatic detachment and injury to nutrient vessels [2, 5] resulting in haematoma formation. Differential diagnoses include surface bone lesions such as bone cysts. The non-medullary location would be atypical for a unicameral bone cyst and lack of fluidfluid l
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