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E2123. Imaging of the Pubis and Pubic Symphysis
Authors
  1. Hanna Tomsan; Mercy Catholic Medical Center
  2. Cristina Olivas-Chacon; Mercy Catholic Medical Center
  3. Jeffrey Poot; Mercy Catholic Medical Center
  4. Justin Mackey; Mercy Catholic Medical Center
  5. Reza Hayeri; Mercy Catholic Medical Center
Background
The pubic symphysis is a unique joint with complex anatomy and the site of attachment for numerous muscles and ligaments. Symphyseal pain is a relatively common, but poorly understood condition, affecting athletes, patients with traumatic pelvic injuries, and pregnant women. It may be severe enough to necessitate admission to the hospital for bed rest. In motor vehicle accidents, pubic symphysis is subjected to lateral compression and multidirectional shear forces that may result in rupture and chronic disabling joint laxity. Pubic symphysis is affected in a variety of other conditions including osteitis pubis, congenital and metabolic disorders, athletic pubalgia, and neoplasms. Although some causes of symphyseal pain may be diagnosed by conventional radiography, magnetic resonance imaging (MRI) is the imaging modality of choice, providing valuable information about the precise nature and extent of the disease. In this pictorial review, we will describe the anatomy and the spectrum of traumatic/non-traumatic pathologic conditions of the pubis and pubic symphysis. Familiarity with these entities will contribute to correct diagnosis and management.

Educational Goals / Teaching Points
1. Review the normal anatomy and biomechanics of the pubis, pubic symphysis, and associated myotendinous and ligamentous structures. 2. Illustrate the spectrum of injuries presenting as athletic pubalgia (e.g. osteitis pubis, rectus abdominis/adductor aponeurosis injury, adductor syndromes), including postoperative imaging and confounding pathologies. 3. Provide examples of traumatic and insufficiency pubic fractures, pubic involvement in pelvic ring fractures, and associated organ injuries. 4. Demonstrate the imaging features of congenital, infectious/inflammatory, neoplastic, and metabolic disorders, affecting pubis and pubic symphysis. 5. Illustrate various non-traumatic causes of pubic diastasis and describe their clinical significance.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
In this case-based educational exhibit, we will review the radiographic, computed tomography (CT), ultrasound, and MRI appearance of traumatic and non-traumatic pathology of the pubis and pubic symphysis with particular attention to underlying disease mechanisms. We will provide a concise review of normal anatomy and biomechanics around the pubis. We will also discuss the role of different imaging modalities and the use of dedicated MR protocols in the diagnosis of these conditions.

Conclusion
The knowledge of normal anatomy, biomechanics, and the broad spectrum of pathology affecting the pubis and pubic symphysis is the prerequisite for correct imaging interpretation. Radiologists should be familiar with the appearances of common entities presenting with pubalgia. The purpose of this exhibit is to provide a comprehensive pictorial review of traumatic and non-traumatic conditions affecting the pubis and pubic symphysis, in order to ensure the accurate diagnosis and guide the appropriate treatment.