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Pubic Ramus Radiolucencies in Infants: The Good, the Bad, and the Indeterminate

¹ Department of Radiology, Children's Hospital Boston, 300 Longwood Ave., Boston MA 02115.
² Department of Radiology, Massachusetts General Hospital, Boston MA.
³ Department of Radiology Services, Greenville Memorial Medical Center, Greenville SC.
⁴ Child Protection Program, Hasbro Children's Hospital, Providence RI.
⁵ Department of Pediatrics, Harborview Medical Center, Seattle WA.

View larger version (28K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —Drawing shows multiple ossification centers of superior pubic rami (arrows) as described by Caffey and Madell. (Reprinted with permission from Caffey J, Madell SH. Ossification of the pubic bones at birth. Radiology 1956; 67:346-350 [9])

View larger version (102K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —1.5-month-old abused male infant with normal variants (case 1). Oblique (A) and anteroposterior (B) radiographs of pelvis reveal regular, sharply marginated vertical radiolucencies (arrows) in both superior pubic rami.

View larger version (107K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —1.5-month-old abused male infant with normal variants (case 1). Oblique (A) and anteroposterior (B) radiographs of pelvis reveal regular, sharply marginated vertical radiolucencies (arrows) in both superior pubic rami.

View larger version (83K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3 —7-month-old abused male infant with normal variants (case 3). Anteroposterior radiograph of pelvis shows two radiolucencies (arrows) in left superior pubic ramus.

View larger version (95K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4 —5-month-old female infant with normal variants (case 14). Postmortem anteroposterior radiograph of pelvis shows radiolucency with marginal sclerosis (arrow) in left superior pubic ramus. Autopsy showed no evidence of trauma to superior pubic ramus.

View larger version (99K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5 —3-month-old abused male infant with fractures (case 4). Anteroposterior radiograph of pelvis shows bilateral irregular oblique superior pubic ramus radiolucencies with marginal sclerosis (arrows) consistent with fractures. Healing Salter-Harris type II injury to right proximal femur is evident.

View larger version (84K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6 —2.5-month-old abused female infant with fracture (case 5). Anteroposterior radiograph of pelvis shows oblique radiolucency with marginal sclerosis (black arrow) in left superior pubic ramus consistent with fracture. Bilateral proximal femoral classic metaphyseal lesions (white arrows) and right proximal femoral subperiosteal new bone formation (arrowhead) are evident.

View larger version (93K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7 —1.5-month-old abused male infant with fracture (case 6). Anteroposterior radiograph of pelvis shows oblique radiolucency in left superior pubic ramus consistent with fracture. Superior fracture margins are slightly displaced (arrow).

View larger version (177K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8A —3-month-old abused female infant with indeterminate findings (case 7). Initial (A) and 2-week follow-up (B) anteroposterior radiographs of left hemipelvis show vertical radiolucency with increased sclerosis (arrow) on follow-up image.

View larger version (163K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8B —3-month-old abused female infant with indeterminate findings (case 7). Initial (A) and 2-week follow-up (B) anteroposterior radiographs of left hemipelvis show vertical radiolucency with increased sclerosis (arrow) on follow-up image.

View larger version (66K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9 —5-month-old female infant with indeterminate findings undergoing evaluation for hip dysplasia (case 9). Anteroposterior radiograph of pelvis reveals vertical radiolucency (arrow) in left superior pubic ramus that completely resolved on follow-up images. Left superior pubic ramus is wider than right.

View larger version (94K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10 —8.5-month-old male infant with indeterminate findings and intussusception (case 10). Anteroposterior radiograph of pelvis shows vertical radiolucency with marginal sclerosis (arrow) in left superior pubic ramus.

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