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"Hanging Drop Sign" in pelvis X-ray.

C Rex1, A Kesavram1, M Harishkumar1

  • 1Rex Ortho Hospital, Coimbatore, Tamilnadu 641002 India.

Indian Journal of Orthopaedics
|May 5, 2025
PubMed
Summary

The "hanging drop sign" on pelvic X-rays is a common finding in seronegative rheumatoid arthritis (SNRA), appearing more frequently than sacroiliitis. This radiological feature, linked to specific muscle origins, aids in SNRA diagnosis.

Keywords:
EnthesopathyHanging drop signPelvis radiographSeronegative rheumatismSpondyloarthropathy

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Area of Science:

  • Radiology
  • Rheumatology
  • Orthopedics

Background:

  • Diagnosis of Seronegative Rheumatoid Arthritis (SNRA) relies on clinical, radiological, and MRI findings.
  • Plain X-rays are crucial for differential diagnosis in rheumatic disorders.
  • Ischiopubic ramus enthesopathy was identified as a common finding in pelvic X-rays of SNRA patients.

Purpose of the Study:

  • To investigate enthesopathy features in pelvic X-rays of SNRA patients.
  • To identify and characterize a specific radiological finding, termed the "hanging drop sign."
  • To compare the prevalence of this sign with sacroiliitis in SNRA.

Main Methods:

  • Analysis of 152 pelvic X-rays from patients diagnosed with SNRA based on ACR/EULAR and ASAS criteria.
  • Documentation of enthesopathy features, including sacroiliitis and calcification/ossification of pelvic muscle and ligament attachments.
  • A cadaveric study of 10 specimens to determine the anatomical origin of the 'hanging drop sign'.

Main Results:

  • The 'hanging drop sign' was observed in 64 out of 110 (58.18%) SNRA patients with radiological evidence.
  • Sacroiliitis was present in 25 patients (22.72%), and other features were noted in 21 patients.
  • Cadaveric dissection confirmed the 'hanging drop sign' corresponds to the origin of the adductor part of the adductor magnus and gracilis muscles in the ischiopubic ramus.

Conclusions:

  • The 'hanging drop sign' is a common radiological finding in the ischiopubic ramus of patients with seronegative rheumatism.
  • This sign originates from the adductor magnus and gracilis muscles.
  • The 'hanging drop sign' is more prevalent than sacroiliitis and serves as a valuable diagnostic tool for SNRA.