Keywords:
Musculoskeletal soft tissue, MR, eLearning
Authors:
R. Del Vescovo, F. Giurazza, R. L. Cazzato, R. F. Grasso, M. Gemignani, B. Beomonte Zobel; Rome/IT
DOI:
10.1594/ecr2013/C-1955
Results
Symmetric hypertrophy of the ileo-psoas muscles (Fig.
1) due to the physical training was observed in all cases.
In the right pubic bone we observed a mild intraspongious signal hyperintensity in T2 weighted fat-sat sequences,
indicating edema as in the condition of pubic osteitis (Fig.
2); in the insertional portion of the right adductor muscles we also noticed a modified intensity suggesting tendinitis,
consistent with a diagnosis of pubalgia.
We detected also a small accumulation of fluid associated with inflammation of the perivisceral ileo-cecal fat (Fig.
3) in the anatomic space situated between the internal oblique and transverse muscles of the abdomen,
the inferior rectus abdominis and the right iliopsoas,
which appeared markedly hypertrophied.
Our diagnosis was pubalgia with associated perivisceral fat tissue inflammation due to iliopsoas hypertrophy.
We supposed that contraction of the iliopsoas,
which happens each time the thigh is flexed in order to kick the ball,
produced rubbing on the perivisceral fat causing inflammation.
To confirm our hypothesis a dynamic ultrasound examination was performed by an ultrasound (US) expert radiologist which assessed rubbing of the iliopsoas on the rectum perivisceral fat while flexing and internally turning the thigh on the abdomen (simulating the kicking motion) was performed.
Eventually a conservative approach with rest,
specific physiotherapy treatment (impact waves on the insertion of the right adductor muscle associated with hyperthermia and manual therapy to reduce the contraction of the psoas) and changes to physical training involving the abdominal muscular wall in order to reduce the iliopsoas muscular hypertrophy and prevent further rubbing on the rectum was suggested by the team medical staff.
After one month the patients rejoined their team and resumed playing soccer; the pain was significantly reduced and the control MRI showed the disappearance of osteitis pubis (Fig.
4); even though a little tenderness persisted for a further two months.