Age / Sex : 52 / F

Chief complaint: Lt ASIS area pain for 5 months

1) What is your impression?

Two weeks later, you can see the final diagnosis with a brief discussion of this case.

(Quiz는 quiz일 뿐이오니 답안은 한 개만 보내주시기 바랍니다)

Courtesy: 김태은(Kim Tae Eun), 대구파티마병원(Daegu Fatima Hospital)

Proximal iliotibial band syndrome

Discussion

Findings: Abnormal signal change with thickening of proximal iliotibial band(ITB) is noted near its enthesis. Perifascial edema is seen along the extent of the ITB from its enthesis at the iliac tubercle to a few centimeters distally.

Differential Diagnosis: Snapping hip syndrome, Trochanteric bursitis

Diagnosis: Proximal iliotibial band syndrome

Discussion: The most well-known clinical symptomatology related to the iliotibial band is ITB friction syndrome (ITBFS), which presents with pain at the lateral distal thigh or knee related to repetitive sliding of the ITB  over the lateral femoral condyle.

 Patients with proximal ITB strain injuries present with pain and tenderness along the iliac crest over the iliac tubercle. These patients are often misdiagnosed or treated for presumed hip-related pathology. Proximal ITB strain represents a unique injury that should be especially considered in patients who are female athletes, particularly runners, or older overweight women who present with pain and tenderness at the iliac tubercle.

MRI findings demonstrate abnormal signal at the iliac tubercle extending caudally along the course of the ITB.  

The proximal ITB enthesis must be included in the FOV for standard hip MRI routinely.

References: 1. Sher I, Umans H, Downie SA, Tobin K, Arora R, Olson TR. Proximal iliotibial band syndrome: what is it and where is it? Skeletal Radiol 2011;40(12):1553–1556.