•A 64 year old man presented to hospital with pain radiating from lumbar region to the right thigh.

•He had a history of lumbar spine surgery having undergone a previous laminectomy L4/5 five years previously

•An XRay of his pelvis was requested- see following image

Radiological diagnosis of Osteochondroma

• Benign neoplasms arising from small cartilage nodules within the periosteum
• More common in the extremities- Distal femur, proximal tibia and proximal humerus in descending order
• They are rare in the pelvis- approximately 5%. Osteochondroma of the pubic ramus is very rare.
• Growth is slow over several years. Can often be asymptomatic.

How would you manage this? Could it be responsible for the patient’s symptoms?

Management Options:

• Excision of a pelvic osteochondroma is usually required if there are pressure symptoms.
• Within the pelvis an osteochondroma can cause a compressive neuropathy, or compressive symptoms on other vital structures such as the bladder
• Pubic ramus mass is more commonly removed for cosmetic reasons
• The location of the osteochondroma in this case is unlikely to be causing his symptoms. It is an incidental finding and was managed conservatively.