Terms including osteitis pubis,
pubalgia,
groin strain,
abdominal muscle tear, and,
more recently,
sports hernia have become common diagnoses on team injury reports [4].
Many of these terms are poorly defined in the medical literature,
adding confusion and leading to wide variability in diagnosis and in treatment modalities.
Athletes with pubalgia usually present with pain in the inguinal region,
which may radiate to the thigh adductor muscle origins or to the scrotum and testicles.
At physical examination,
point tenderness is often localized to the external ring of the inguinal canal and the pubic tubercle,
the lower rectus abdominis musculature,
or the pubic symphysis,
but there is no palpable hernia [4].
Until recently,
imaging was thought to be unreliable or of little use for the diagnosis of athletic pubalgia [1].
However,
improved knowledge of anatomic structures,
pathophysiologic changes,
and clinical findings associated with athletic pubalgia has resulted in improved imaging techniques [5].
Because many pathophysiologic processes may manifest as pubic and inguinal pain,
an MR imaging survey of the pelvis is now recommended during the initial evaluation [1,
4].
Once injury to the pubic region is confirmed,
dedicated imaging of the anterior pubic musculoskeletal structures is recommended [5].
Frequently,
images obtained with fluid-sensitive sequences allow direct visualization of tears involving the rectus abdominis–adductor aponeurosis,
which appear as irregular areas with signal intensity like that of fluid undermining the aponeurosis.
Other findings commonly associated are abnormal isolated marrow signal intensity at the anterior-inferior aspect of the pubic body and deep to the rectus abdominis.
Sometimes also osseous productive changes and subchondral cysts in the pubic symphysis are observed.
In some patients,
an initial tendinous injury precedes clinical symptoms and MR imaging findings of osteitis pubis [1].
Athletes frequently develop hypertrophic muscle volumes,
depending on the type of training they practice.
In soccer players there is a symmetric development of the muscles of the thigh and of the lower abdomen [3].
Sometimes this condition can lead to compression of the surrounding tissues and can be responsible for a variety of clinical signs,
especially in the pelvis.
In the literature several examples of this condition related to hypertrophied iliopsoas muscles have been described,
as occurred in our patient; teardrop bladder is one of the most frequent conditions described [6].
In 1987 Zeiss et al. described the case of a bodybuilder with a marked hypertrophy of the psoas muscle producing a unilateral extrinsic mass effect on the median cecum with acute abdominal symptoms [7].
To our knowledge no previous cases of visceral inflammation due to muscle hypertrophy in athletes have been previously reported.
In conclusion we suggest the use of MR imaging in cases of athletes with groin pain; furthermore if no pathological evidence can be detected,
a study of the pelvic structures should be performed in order to assess relations between hypertrophied muscles and visceral structure.