Osteitis Pubis

Osteitis pubis is a nonspecific inflammatory disease of the symphysis pubis. The involvement is symmetrical, but the unilateral type is not rare. It develops after delivery and a pelvic operation such as prostatectomy or bladder surgery, although idiopathic occurrence in men or nulliparous women has been reported (Numaguchi 1971; Segal and Kellogg 1954). The histological feature is simple bony condensation (Rendich and Shapiro 1936). Clinically, the postoperative type is painful, whereas the postpartum type is usually asymptomatic. In many aspects osteitis pubis bears strong resemblance to osteitis condensans ilii, and both are considered related to physical stress. Indeed, the two conditions can occur simultaneously. Radiographic features include cortical erosions, sclerosis, joint space narrowing, and rarely bony ankylosis (Fig. 7.4A), and vary according to the stage and duration of the disease.

Pinhole scintigraphy is useful in the study of osteitis pubis. Accurate judgment of abnormal uptake in the symphysis pubis in women of childbearing age is often difficult especially on ordinary scintigraphs because the pubic bone normally accumulates tracer significantly in this age group. However, pinhole scintigraphy shows the tracer uptake confined to the bones about the symphysis with narrowed joint (Fig. 7.4B). It is helpful to note that the physiological uptake is uniform and not localized to the cortex (Fig. 4.26). In a milder form, uptake may be subtle yet typically para-articular in location (Fig. 7.5B). Repeated pregnancies and deliveries may lead to recurrences, causing prominent uptake in the pubic bone that is deformed with a gaping symphysis (Fig. 7.6). In contrast and understandably, quiescent osteitis accumulates little tracer although radiographic changes remain (Fig. 7.7).

Scintigraphy Symphysis

Fig. 7.4A, B Osteitis (condensans) pubis. A Anteroposterior radiograph of the pubis in a 25-year-old woman reveals irregular erosions and sclerosis in the para-articular bones of the symphysis (arrowheads). The lower joint space is narrowed, but the upper joint space appears falsely widened due to erosion (arrowheads). B Anterior pinhole scan localizes extremely intense tracer uptake in the para-articular pubic bones (arrows), distinguishing it from the less intense uptake in the normal areas. Such a crucial difference in tracer uptake cannot be demonstrated by ordinary scintigraphy. Here also the articular space is narrowed in the lower aspect but falsely widened in the upper

Fig. 7.4A, B Osteitis (condensans) pubis. A Anteroposterior radiograph of the pubis in a 25-year-old woman reveals irregular erosions and sclerosis in the para-articular bones of the symphysis (arrowheads). The lower joint space is narrowed, but the upper joint space appears falsely widened due to erosion (arrowheads). B Anterior pinhole scan localizes extremely intense tracer uptake in the para-articular pubic bones (arrows), distinguishing it from the less intense uptake in the normal areas. Such a crucial difference in tracer uptake cannot be demonstrated by ordinary scintigraphy. Here also the articular space is narrowed in the lower aspect but falsely widened in the upper

Fig. 7.5A, B Osteitis pubis in the early phase. A Anteroposterior radiograph of the pubis in 41-year-old man shows mild eburnation in the para-articular bones with contour irregularity (arrowheads). B Anterior pinhole scintigraph indeed shows subtle, abnormal tracer uptake in the immediate para-articular bones (arrows). The articular space is not narrowed. Compare with the tracer uptake in the normal pubic bones (Fig. 4.26)

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