Figure 12.

Pubic osteomyelitis. A 70-year-old female, with a history of previous surgery and radiotherapy for carcinoma of the cervix, presented with an open wound over the symphysis pubis. The clinical concern was the possibility of local tumor recurrence in the pubic symphysis region. The patient was subsequently diagnosed as having osteomyelitis. Sagittal T1 MRI (a) shows a soft tissue mass (asterisk) with underlying destruction of the symphysis pubis (arrowhead). Note the presence of air in the bladder (B) from a vesicovaginal fistula. Biopsy and culture proved the changes were due to osteomyelitis, rather than tumor recurrence. AP Radiograph (b) showing cortical irregularity and destruction in the region of pubic symphysis with widening of the joint (asterisk). Gas is projected within the symphysis pubis and adjacent soft tissues in keeping with the known vesicovaginal fistula.