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Nontraumatic Avulsions of the Pelvis

Liem T. Bui-Mansfield1,2,3, Felix S. Chew2, Leon Lenchik2, Mitch J. Kline4 and Carol A. Boles2

1 Department of Radiology, Keller Army Community Hospital, West Point, NY 10996.
2 Department of Radiology, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157-1088.
3 Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814-4799.
4 Section of Musculoskeletal Radiology, Diagnostic Radiology/A21, Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44195.



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  		Fig. 1A. —57-year-old woman with breast cancer, from our case files, who presented with left hip pain. Oblique radiograph of left hip joint reveals avulsion fracture (arrow) of lesser trochanter.

 


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  		Fig. 1B. —57-year-old woman with breast cancer, from our case files, who presented with left hip pain. Oblique coronal T1-weighted MR image shows hypointense lesion (arrowhead) in proximal femur involving lesser trochanter.

 


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  		Fig. 1C. —57-year-old woman with breast cancer, from our case files, who presented with left hip pain. Oblique coronal T2-weighted MR image shows abnormal hyperintense lesion (arrow) in proximal femur involving lesser trochanter, consistent with bony metastasis.

 


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  		Fig. 2A. —54-year-old woman with breast cancer who was recently diagnosed with adenocarcinoma of lung. Anterior scintigraphic image of pelvis shows multiple sites of intense focal uptake, consistent with metastases.

 


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  		Fig. 2B. —54-year-old woman with breast cancer who was recently diagnosed with adenocarcinoma of lung. Axial CT image of pelvis reveals multiple sclerotic bony metastases (thin arrows) involving right half of sacrum and left anterosuperior iliac spine, which has an avulsion fracture. Radiolucent defect in left ilium (thick arrow) is site of bone graft obtained for prior lumbar spine fusion.

 


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  		Fig. 2C. —54-year-old woman with breast cancer who was recently diagnosed with adenocarcinoma of lung. Anteroposterior radiograph of pelvis obtained 2 weeks after CT of abdomen and pelvis shows pathologic fractures in left iliac crest extending through anterosuperior iliac spine and right superior and inferior pubic rami. Additional sclerotic bony metastases can be seen in right anterior iliac spine, left ilium, and right half of sacrum (arrowheads). Screws from prior spinal fusion are seen in L4-5 disk space.

 


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  		Fig. 3A. —81-year-old man with elevated serum prostate-specific antigen whose biopsy of prostate revealed adenocarcinoma. Posterior scintigraphic image of pelvis reveals focal increased uptake in right ischial tuberosity (arrowhead).

 


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  		Fig. 3B. —81-year-old man with elevated serum prostate-specific antigen whose biopsy of prostate revealed adenocarcinoma. Anteroposterior radiograph of pelvis shows avulsion fracture of right ischium (arrow).

 


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  		Fig. 3C. —81-year-old man with elevated serum prostate-specific antigen whose biopsy of prostate revealed adenocarcinoma. Axial CT image of pelvis reveals sclerotic metastasis in right ischial tuberosity. Lytic area (arrow) is caused by bony resorption adjacent to avulsion fracture.

 


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  		Fig. 4A. —59-year-old woman with non-Hodgkin's lymphoma who presented with right hip pain. Anteroposterior radiograph of pelvis shows lytic destruction of right superior and inferior public rami. The right acetabulum was sclerotic with cortical irregularity in right anteroinferior iliac spine (arrow). Surgical staples are from recent surgical biopsy of right anterosuperior iliac spine.

 


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  		Fig. 4B. —59-year-old woman with non-Hodgkin's lymphoma who presented with right hip pain. Oblique radiograph of right hip reveals avulsion fracture of right anteroinferior iliac spine (arrow).

 


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  		Fig. 4C. —59-year-old woman with non-Hodgkin's lymphoma who presented with right hip pain. Coronal T1-weighted MR image of pelvis shows tumor infiltration of entire right pelvic bone and right proximal femur.

 

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