Post-radiotherapy osteomyelitis of the symphysis pubis: computed tomographic features

We report the clinical and computed tomography (CT) features of seven patients with osteomyelitis of the symphysis pubis following radiotherapy for bladder (n=4) or cervical (n=3) carcinoma. The patients presented with fistulae (n=5), pain (n=1) or small bowel obstruction (n=1) between 6 and 19 years after radiotherapy. The diagnosis was confirmed by surgery with histology or bacteriology of the symphysis pubis and/or associated abscess in all patients. In addition to bone destruction, other features identified on CT included abscesses, bowel loops adherent to the symphysis pubis and/or communicating with an abscess cavity, a soft tissue mass enveloping the residual bone, and fistulae. The combination of clinical and radiological features suggests osteomyelitis and, for patients who have had pelvic radiotherapy, this treatable condition should be included in the differential diagnosis of solitary symphysis pubis destruction.