Multimodality imaging evaluation for iliac crest apophysis avulsion injury

doi:10.1016/j.radcr.2019.05.016

Case Reports

. 2019 Jun 6;14(8):986-988.

doi: 10.1016/j.radcr.2019.05.016. eCollection 2019 Aug.

Multimodality imaging evaluation for iliac crest apophysis avulsion injury

Nandan Keshav¹, Nupur Verma², Manuela Matesan³, Fatemeh Behnia³, Saeed Elojeimy¹

Affiliations

¹ Department of Radiology, University of New Mexico, 1 University of New Mexico, MSC 10-5530, Albuquerque, NM 87131, USA.
² Department of Radiology, College of Medicine, University of Florida, Gainesville, FL, USA.
³ Department of Nuclear Medicine, University of Washington, Seattle, WA, USA.

PMID: 31198480
PMCID: PMC6556494
DOI: 10.1016/j.radcr.2019.05.016

Case Reports

Multimodality imaging evaluation for iliac crest apophysis avulsion injury

Nandan Keshav et al. Radiol Case Rep. 2019.

. 2019 Jun 6;14(8):986-988.

doi: 10.1016/j.radcr.2019.05.016. eCollection 2019 Aug.

Authors

Nandan Keshav¹, Nupur Verma², Manuela Matesan³, Fatemeh Behnia³, Saeed Elojeimy¹

Affiliations

¹ Department of Radiology, University of New Mexico, 1 University of New Mexico, MSC 10-5530, Albuquerque, NM 87131, USA.
² Department of Radiology, College of Medicine, University of Florida, Gainesville, FL, USA.
³ Department of Nuclear Medicine, University of Washington, Seattle, WA, USA.

PMID: 31198480
PMCID: PMC6556494
DOI: 10.1016/j.radcr.2019.05.016

Abstract

A young cross-country athlete with left thigh pain, and a recent negative MRI of the left hip was referred to nuclear medicine for bone scan imaging. A 3-phase Tc-99m methylene diphosphonate bone scan was performed and revealed left iliac crest apophysis avulsion. This case illustrates that 3-phase bone scan is a great adjunct in the evaluation of sports injuries especially in athletes presenting with vague nonlocalizing symptoms, and prior negative radiographic or MRI imaging.

Keywords: Bone scan; Iliac crest apophysis injury.

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Figures

Fig 1 — **Fig. 1**
Anterior and posterior blood pool images of a Tc99m-MDP bone scan showing asymmetric increased blood pooling in the region of the left iliac crest apophysis.

Fig 2 – — **Fig. 2**
Anterior and posterior 3 hours delayed images of a Tc99m-MDP bone scan showing asymmetric increased radiotracer deposition in the region of the left iliac crest apophysis, better appreciated on the posterior views.

Fig 3 – — **Fig. 3**
Bone scan SPECT 3D MIP reconstructed image demonstrating asymmetric increased radiotracer deposition in the region of the left anterior iliac crest extending inferiorly to the region of the left anterior iliac spine.

Fig 4 – — **Fig. 4**
Frontal pelvis radiograph showing a mildly displaced avulsion fracture of the left iliac crest apophysis.

Fig 5 – — **Fig. 5**
Axial (A) and coronal (B) STIR MRI images showing increased T2 signal in the region of the left iliac crest apophysis.

See this image and copyright information in PMC

References

1. Coulier B. Acute avulsion of the iliac crest apophysis in an adolescent indoor soccer. J Belg Soc Radiol. 2015;99(2):20–24. - PMC - PubMed
2. Coulier B.Acute avulsion of the iliac crest apophysis in an adolescent indoor soccer. J Belg Soc Radiol. 2015;99(2):20–24. - PMC - PubMed
1. Kjellin I., Stadnick M.E., Awh M.H. Orthopaedic magnetic resonance imaging challenge: apophyseal avulsions at the pelvis. Sports Health. 2010;2(3):247–251. - PMC - PubMed
2. Kjellin I., Stadnick M.E., Awh M.H.Orthopaedic magnetic resonance imaging challenge: apophyseal avulsions at the pelvis. Sports Health. 2010;2(3):247–51. - PMC - PubMed
1. Stevens M.A., El-Khoury G.Y., Kathol M.H., Brandser E.A., Chow S. Imaging features of avulsion injuries. Radiographics. 1999;19(3):655–672. - PubMed
2. Stevens M.A., El-Khoury G.Y., Kathol M.H., Brandser E.A., Chow S.Imaging features of avulsion injuries. Radiographics. 1999;19(3):655–72. - PubMed
1. Hébert K.J., Laor T., Divine J.G., Emery K.H., Wall E.J. MRI appearance of chronic stress injury of the iliac crest apophysis in adolescent athletes. AJR Am J Roentgenol. 2008;190(6):1487–1491. - PubMed
2. Hébert K.J., Laor T., Divine J.G., Emery K.H., Wall E.J.MRI appearance of chronic stress injury of the iliac crest apophysis in adolescent athletes. AJR Am J Roentgenol. 2008;190(6):1487–91. - PubMed
1. Sanders T.G., Zlatkin M.B. Avulsion injuries of the pelvis. Semin Musculoskelet Radiol. 2008;12(1):42–53. - PubMed
2. Sanders T.G., Zlatkin M.B.Avulsion injuries of the pelvis. Semin Musculoskelet Radiol. 2008;12(1):42–53. - PubMed

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[1] Coulier B. Acute avulsion of the iliac crest apophysis in an adolescent indoor soccer. J Belg Soc Radiol. 2015;99(2):20–24. - PMC - PubMed

Coulier B.Acute avulsion of the iliac crest apophysis in an adolescent indoor soccer. J Belg Soc Radiol. 2015;99(2):20–24. - PMC - PubMed

[2] Coulier B. Acute avulsion of the iliac crest apophysis in an adolescent indoor soccer. J Belg Soc Radiol. 2015;99(2):20–24. - PMC - PubMed

[3] Coulier B.Acute avulsion of the iliac crest apophysis in an adolescent indoor soccer. J Belg Soc Radiol. 2015;99(2):20–24. - PMC - PubMed

[4] Kjellin I., Stadnick M.E., Awh M.H. Orthopaedic magnetic resonance imaging challenge: apophyseal avulsions at the pelvis. Sports Health. 2010;2(3):247–251. - PMC - PubMed

Kjellin I., Stadnick M.E., Awh M.H.Orthopaedic magnetic resonance imaging challenge: apophyseal avulsions at the pelvis. Sports Health. 2010;2(3):247–51. - PMC - PubMed

[5] Kjellin I., Stadnick M.E., Awh M.H. Orthopaedic magnetic resonance imaging challenge: apophyseal avulsions at the pelvis. Sports Health. 2010;2(3):247–251. - PMC - PubMed

[6] Kjellin I., Stadnick M.E., Awh M.H.Orthopaedic magnetic resonance imaging challenge: apophyseal avulsions at the pelvis. Sports Health. 2010;2(3):247–51. - PMC - PubMed

[7] Stevens M.A., El-Khoury G.Y., Kathol M.H., Brandser E.A., Chow S. Imaging features of avulsion injuries. Radiographics. 1999;19(3):655–672. - PubMed

Stevens M.A., El-Khoury G.Y., Kathol M.H., Brandser E.A., Chow S.Imaging features of avulsion injuries. Radiographics. 1999;19(3):655–72. - PubMed

[8] Stevens M.A., El-Khoury G.Y., Kathol M.H., Brandser E.A., Chow S. Imaging features of avulsion injuries. Radiographics. 1999;19(3):655–672. - PubMed

[9] Stevens M.A., El-Khoury G.Y., Kathol M.H., Brandser E.A., Chow S.Imaging features of avulsion injuries. Radiographics. 1999;19(3):655–72. - PubMed

[10] Hébert K.J., Laor T., Divine J.G., Emery K.H., Wall E.J. MRI appearance of chronic stress injury of the iliac crest apophysis in adolescent athletes. AJR Am J Roentgenol. 2008;190(6):1487–1491. - PubMed

Hébert K.J., Laor T., Divine J.G., Emery K.H., Wall E.J.MRI appearance of chronic stress injury of the iliac crest apophysis in adolescent athletes. AJR Am J Roentgenol. 2008;190(6):1487–91. - PubMed

[11] Hébert K.J., Laor T., Divine J.G., Emery K.H., Wall E.J. MRI appearance of chronic stress injury of the iliac crest apophysis in adolescent athletes. AJR Am J Roentgenol. 2008;190(6):1487–1491. - PubMed

[12] Hébert K.J., Laor T., Divine J.G., Emery K.H., Wall E.J.MRI appearance of chronic stress injury of the iliac crest apophysis in adolescent athletes. AJR Am J Roentgenol. 2008;190(6):1487–91. - PubMed

[13] Sanders T.G., Zlatkin M.B. Avulsion injuries of the pelvis. Semin Musculoskelet Radiol. 2008;12(1):42–53. - PubMed

Sanders T.G., Zlatkin M.B.Avulsion injuries of the pelvis. Semin Musculoskelet Radiol. 2008;12(1):42–53. - PubMed

[14] Sanders T.G., Zlatkin M.B. Avulsion injuries of the pelvis. Semin Musculoskelet Radiol. 2008;12(1):42–53. - PubMed

[15] Sanders T.G., Zlatkin M.B.Avulsion injuries of the pelvis. Semin Musculoskelet Radiol. 2008;12(1):42–53. - PubMed

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Multimodality imaging evaluation for iliac crest apophysis avulsion injury

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Multimodality imaging evaluation for iliac crest apophysis avulsion injury

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Abstract

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