Plexiform Neurofibromatosis in a Woman With a Pubic Ramus Stress Fracture

Area of Science:

• Musculoskeletal Imaging
• Orthopedic Physical Therapy
• Sports Medicine

Background:

• A 22-year-old female soldier presented with insidious groin pain during Army Basic Combat Training.
• Initial radiographs were noncontributory; a bone scan suggested a left inferior pubic ramus stress fracture.

Observation:

• The patient developed a palpable mass and severe pain upon return from convalescent leave.
• Magnetic resonance imaging (MRI) was performed due to persistent symptoms and a palpable mass.

Findings:

• MRI revealed plexiform neurofibromas, including a left buttock mass.
• The imaging also confirmed the pre-existing left inferior pubic ramus stress fracture.

Implications:

• This case underscores the necessity of advanced imaging modalities like MRI for complex presentations.
• It highlights the potential co-occurrence of stress fractures and soft tissue masses, such as neurofibromas, in active individuals.
• Consideration of neurofibromas is crucial in differential diagnoses for persistent pain and masses in athletes.