Subperiosteal hematoma of the iliac bone: imaging features of acute and chronic stages with emphasis on pathophysiology

Abstract

Subperiosteal iliac hematoma is rare but has typical imaging findings that may present acutely in adolescents or chronically in asymptomatic adults.

Incidental finding in a young man

“…Rarely, it can be seen in patients with acetabular fracture [4]. The most widely accepted mechanism, is that of the periosteum of the inner iliac bone surface being avulsed during sudden forceful traction of the iliacus muscle [1,[5][6][7]. This theory is supported by the fact that subperiosteal hematomas develop mainly in children and teenagers, in whom the periosteum is more easily stripped from the bone than in adults [7,8].…”

“…Just as in our patient, subperiosteal hematomas of the iliac bone most commonly present as incidental findings in crosssectional images [1]. While blunt trauma to the posterior part of the back or buttock is the most common cause, some of them are not caused by direct impact but rather by the hyperextension of the hip [1][2][3].…”

“…While blunt trauma to the posterior part of the back or buttock is the most common cause, some of them are not caused by direct impact but rather by the hyperextension of the hip [1][2][3]. Rarely, it can be seen in patients with acetabular fracture [4].…”

“…Clinically, the patients are asymptomatic, or only demonstrate mild discomfort immediately after the injury [1]. Delayed painful hip movement can follow.…”

“…Between the hematoma and the iliac bone is a smooth thin layer of ghost native cortex. The combination of all these features, when seen, is almost pathognomonic [1] and allows one to make a clear diagnosis confidently, in both CT and MRI images.…”