Reumatología Clínica (English Edition) Reumatología Clínica (English Edition)

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DOI: 10.1016/j.reumae.2016.07.009
Images in Clinical Rheumatology
Van Neck-Odelberg Disease: Another Cause of Limp in Childhood
Enfermedad de Van Neck-Odelberg: una causa más de cojera en la infancia
Isla Morante Boladoa,, , Marina Ortega Navaridasb, Daniel Clemente Garuloc, Juan Carlos López Robledilloc
a Servicio de Reumatología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
b Servicio de Pediatría, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
c Servicio de Reumatología Pediátrica, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
Received 23 December 2015, Accepted 11 July 2016
Introduction

Ischiopubic synchondrosis (IPS) is a temporary joint that exists only in childhood, during bone maturation. On occasion it produces pain, whereas on others, it is an incidental finding revealed by plain radiography. Given its tumor-like aspect, it is necessary to perform magnetic resonance imaging (MRI) to differentiate it from pathological conditions.

Case Report

The patient was an 8-year-old boy with no significant medical history. He reported that, for the last year, he was having weekly episodes of intense pain in right lower limb that lasted at least an hour. The pain was located in anterior aspect of his thigh and gluteal region, and limited his mobility. He had no fever or constitutional symptoms. The clinical signs and symptoms remitted with rest and the usual analgesics.

Physical examination confirmed that the child was obese (body mass index=24; >97th percentile). There was no evidence of inflammation, limitation of mobility or neurological deficits. Complete blood count, laboratory tests and acute-phase reactants were normal.

An anteroposterior radiograph of the pelvis (Fig. 1) revealed enlargement of right-sided IPS, with small irregularities of pseudotumoral aspect. Magnetic resolution produced (Fig. 2) an asymmetrical and irregular image, like a “fibrous bridge”, affecting right ischiopubic syndesmosis (T1) and a hyperintense signal with associated soft-tissue edema in T2-weighted and short tau inversion recovery (STIR) sequences. This is all compatible with a diagnosis of “Van Neck-Odelberg osteochondritis”.

Fig. 1.
(0.07MB).

Anteroposterior radiograph of pelvis: swelling of right ischiopubic synchondrosis.

Fig. 2.
(0.08MB).

Axial magnetic resonance imaging (short tau inversion recovery) of pelvis: swelling of right ischiopubic synchondrosis, with irregular margins. Signal alteration in bone marrow and edema of the surrounding soft tissue.

Discussion

Van Neck-Odelberg disease is a benign process that develops in children between the ages of 4 and 16 years. It is characterized by pain in the lower limb due to osteochondritis of the ischiopubic ramus.1,2

There is swelling of the IPS with no clinical manifestations, but it can be associated with pain in the thigh, groin region or buttock, with limitation of the mobility of the extremity and limping.3

Plain radiography usually shows an enlargement of the synchondrosis with radiolucent and osteolytic areas. The typical MRI findings include changes in bone marrow and perilesional soft-tissue edema.2–4

The tumor-like appearance in radiographs may lead to a diagnosis of stress fracture, an infectious process or tumor.1–5 The absence of fever and normal results on laboratory tests facilitates the differential diagnosis.1

This condition usually has a favorable outcome after 2 or 3 weeks of anti-inflammatory therapy and rest.2,3,5,6

Ethical DisclosuresProtection of human and animal subjects

The authors declare that no experiments were performed on humans or animals for this study.

Confidentiality of data

The authors declare that they have followed the protocols of their work center on the publication of patient data.

Right to privacy and informed consent

The authors declare that no patient data appear in this article.

Conflicts of Interest

The authors declare they have no conflicts of interest.

References
1
A. Wait,T. Gaskill,Z. Sarwar,M. Busch
Van Neck disease: osteochondrosis of the ischiopubic synchondrosis
J Pediatr Orthop, 31 (2011), pp. 520-524 http://dx.doi.org/10.1097/BPO.0b013e31821f9040
2
P. Schvartzman,A. Varela,V. Alarcón,D. Salgado,E. Mondello
Síndrome de sincondrosis isquiopúbica. Enfermedad de Van Neck-Odelberg
Rev Argent Radiol, 79 (2015), pp. 110-112
3
L. Macarini,T. Lallo,T. Milillo,S. Muscarella,R. Vinci,L.P. Stoppino
Case report: multimodality imaging of van Neck-Odelberg disease
Indian J Radiol Imaging, 1 (2011), pp. 107-110
4
D. Ceroni,M. Mousny,M. Anooshiravani-Dumont,A. Buerge-Edwards,A. Kaelin
MRI abnormalities of the ischiopubic synchondrosis in children: a case report
Acta Orthop Belg, 70 (2004), pp. 283-286
5
A.M. Herneth,M.O. Philipp,M.L. Pretterklieber,C. Balassy,F.W. Winkelbauer,C.F. Beaulieu
Asymmetric closure of the ischiopubic synchondrosis in pediatric patients: correlation with foot dominance
AJR Am J Roentgenol, 182 (2004), pp. 361-365 http://dx.doi.org/10.2214/ajr.182.2.1820361
6
F. Oliveira
Differential diagnosis in painful ischiopubic synchondrosis (IPS): a case report
Iowa Orthop J, 30 (2010), pp. 195-200

Please cite this article as: Morante Bolado I, Ortega Navaridas M, Clemente Garulo D, López Robledillo JC. Enfermedad de Van Neck-Odelberg: una causa más de cojera en la infancia. Reumatol Clin. 2017. http://dx.doi.org/10.1016/j.reuma.2016.07.001


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Copyright © 2015. Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología

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DOI: 10.1016/j.reumae.2016.07.009