Late presentation of a subiliacus haematoma after an apophyseal injury of the anterior inferior iliac spine

Abstract

Apophyseal injuries are particularly common in adolescents when the growth spurt that accompanies puberty places increased strain on developing bones and muscles. Bone growth in particular exceeds that of soft tissues resulting in relatively tight musculature and subsequent excessive strain at these sites of tendon insertion into bone. We describe a case of a young athlete who presented with chronic hip pain after an anterior inferior iliac spine apophyseal injury with subsequent haematoma formation under the iliacus muscle. There was no evidence of a bleeding disorder. In view of the late presentation, he was managed non-operatively. This injury requires a low threshold for early cross-sectional imaging. The delay in management in this case did not lead to any long-term sequelae.

Figure 1

Plain X-ray of the pelvis (A) and right hip (B) did not reveal any obvious abnormality.

Figure 2

Fat-saturated coronal and axial MRI of the pelvis. White arrows show (A) a lentiform collection under the right iliacus muscle communicating with (B and C) inflammatory changes around the anterior inferior iliac spine (AIIS) and widening of the right AIIS apophyses.