[Hip 6yrs Bilateral Pain 38F.jpg]
These are images from (bilateral) hip MRI in open 1.2T MRI
There is bandlike marrow edema within both anterior Sacral ala with ? fracture. There is subchondral Dark T1/PDFS marrow signal on both sides of joint; I don’t see joint widening, erosions or synovitis.
There is bilateral SI pericapsular edema.
I’m considering chronic sacral stress fractures, but then I can’t explain the SI pericapsular edema.
I’m wondering if there is acute on chronic sacroiliitis and possible superimposed stress fractures? That seems crazy.
And I’m not sure if there is too much sclerosis on both sides of both SI joints to consider osteitis condensans ilii…but then I can’t explain either the pericapsular edema or the bilateral sacral edema.
[Hip 6yrs Bilateral Pain 38F (1).jpg]
[Hip 6yrs Bilateral Pain 38F (2).jpg]
I received several comments. There is near universal consensus that there are bilateral sacral stress fractures or stress reaction, more prominent on the right. After sharing additional mid sagittal images of the lower lumbar spine and sacrum and of the pubic symphysis, Rob Lambert is convinced that the findings are all biomechanical, with no possibility of Spondyloarthropathy. The sagittal spine image shows a bit of a steep lumbosacral angle that might predispose to increased stress.
Whether or not there is underlying osteitis condensans ilii remains a question, Lucas da Gama Lobo pointed out “subchondral bone is preserved. Edema is mechanical in nature”. I am convinced. Thank you everyone who consulted.
Have you seen this in any more cases? I have a near identical case in same age symptomatic woman with history of svd, wondering if the osteitis condensans and edema are part of the same mechanical process