"Can't touch this": pelvic digit, pelvic rib

This poster is published under an open license. Please read the disclaimer for further details.

Congress:

ECR 2016

Poster Number:

C-0763

Type:

Educational Exhibit

Keywords:

Education and training, Developmental disease, Congenital, Normal variants, Education, Diagnostic procedure, MR, CT, Conventional radiography, Musculoskeletal soft tissue, Musculoskeletal bone, Extremities

Authors:

M. Cs. Jánvári, G. Mózsik, E. Riedl; Budapest/HU

DOI:

10.1594/ecr2016/C-0763

DOI-Link:

https://dx.doi.org/10.1594/ecr2016/C-0763

Fig. 1: Patient with radiating lumbar pain. Prominent pelvic digit with...

Fig. 2: Same patient as Fig. 1. Lauenstein's view. Note the pseudo-articulation between...

Fig. 3: Incidental finding on native KUB study. Pelvic digit dorsal to the right...

Fig. 4: Patient with radiating lumbar pain. Large pelvic digit with pseudo-articulation...

Learning objectives

To understand the concept of benign, skeletal "don't touch" lesions through pelvic digit and pelvic rib, andto stress the importance of a proper radiologic report that shall promote patient safety.

Background

First describedby Dan Sullivan and William S. Cornwell in 1974, pelvic rib and pelvic digit arerare, benign, congenital anomalies believed to develop within the first six weeks of embryogenesis, in which rib or fingerlike boney structures(that may even form pseudo-articulations) arise in soft tissues around the pelvis, generally unilaterally. With pathognomonic radiographic appearance, they arereckoned amongst skeletal "don't touch" lesions, obviating further diagnostic workup. Benign of origin, they areincidental findings, however very few symptomatic cases have also been reported, those shall be differentiated from myositis...

Findings and procedure details

Fourcases of pelvic digit/rib are presented, incidentally foundby the authors during their daily routine between January 2014 and October2015. Frequency might be higherthan we thought before, as unrevealed cases are presumably reported as myositis ossificans.

Conclusion

Skeletal "don't touch" lesions among them pelvic digit, and pelvic rib have characteristic radiographic appearance that obviates further diagnostic workup. Radiologists' role is to report incidental findings without any differentials to reassure the clinican of its benign origin and protect the patient from unnecessary, potentially harmful examinations.

Personal information

M. Cs. Jánvári1 (contact), G. Mózsik1, E. Riedl2 Department of Radiology, Hungarian Defence Forces Medical Center, Budapest, Hungary.

References

Khatri K, Goyal D, Paul R, Sandhu HS. Two Pelvic Digits on Same Side: Double Trouble? J Clin Diagn Res. 2015 Jun;9(6):RD04-5. Balbaloglu O, Okur A, Erkoc MF. Common symptom but rare etiology: hip pain caused by pelvic digit. Rheumatol Int. 2015 Feb;35(2):375-6. Bouzaïdi K, Daghfous A, Chahbani H, Bouassida M, Jabnoun F, Rezgui Marhoul L. Pelvic digit: a rare lesion. Diagn Interv Imaging. 2014 Nov;95(11):1117-20. Miyakoshi N, Kobayashi A, Hongo M, Shimada Y. Sacral rib: an uncommon congenital anomaly. Spine J. 2015 Jun 1;15(6):e35-8....