Dirk Schaper (Kinderchirurgie Barbara-Krankenhaus Halle/S.)  

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8 Years  

Male  

Pelvis-Bones  

other  

8 year-old boy with pollakisuria, leucocyturia, bacteriuria and febrile temperatures. First, an antibiotic therapy was begun, but without improvement and a new increase in temperature, the patient was admitted to the hospital. Palpitory pain in the right lower quadrant and near the pubic bone, pain on percussion in the kidney, urine findings were normal. Thoracic x-ray was normal, sinuses normal, lumbar puncture normal, pelvic overview showed a spherical enlargement on the lower pubic ramus.
In the MRIs which the patient brought from an outside clinic, osteomyelitis of the left pelvic ramus was suspected (not sure, since the parents declined contrast media).  

Passing intrasossary vascularization defect, which causes an aseptic bone necrosis.  

<- view X-Ray 1

X-Ray 1: Pelvic overview with expansion in the transition of ossic ischeal ramus to the inferior ossic pubic ramus.





<- view X-Ray 2

X-Ray 2: Spotfilm

 

Total constellation (Consens)  

Osteomyelitis, neoplasm  

Under the assumption of a bone inflammation in van Neck's disease, the antibiotic treatment is continued. The patient's fever lowered and quick disappearance of symptoms.

A further scintigraphy could not confirm an inflammatory change, in contrast to MRI.

Six months after treatment, the patient is still clinically healthy.  

This case was problematic on the whole. Aside from the typical findings of a van Neck's disease, clinical symptoms were in the foreground and almost unremarkable inflammatory lab values. Further imaging techniques could bring us information, more differential diagnoses were made. If the inflammation really was due to a pubic bone osteomyelitis can not be confirmed nor denied.
Because of the undoubting radiological findings, we did not perform a biopsy.  

N/A  

1. Medline:
Petje,G., radler,C., Kriegs-Au,G., Ganger,G., Grill,F.
Aseptische Knochennekrosen im Kindesalter
Orthopäde 2002 31:1027-1038  

aseptic bone necrosis, van Neck, complicated van Neck's disease, pollakisuria, leucocyturia, bacteriuria, fever, Van Neck-Odelberg disease, Van Neck-Odelberg syndrome, juvenile osteochondrosis, child, childhood, pediatric radiology  

Dirk Schaper. Complicated van Neck's Disease. PedRad [serial online] vol 3, no. 6.
URL: www.PedRad.info/?search=20030617204913