Pelvic finger showing signs of medical issue, linked to surgical and pathology investigations

Pelvic finger showing signs of medical issue, linked to surgical and pathology investigations

A unique case has come to light, where a pelvic digit, a rare, benign bone formation resembling a finger or rib adjacent to the pelvis, was found to be the cause of both organic erectile dysfunction and severe pain in a 65-year-old farmer.

Pelvic digits, also known as pelvic fingers or pelvic ribs, are typically asymptomatic and discovered incidentally on imaging. However, in this case, the digit was causing discomfort while cycling or riding a motorcycle, and worsening pain during sitting and kneeling movements.

The pelvic digit was confirmed through a series of imaging tests, including radiographs, CT scans, and MRI. The MRI revealed a well-defined cortico-medullary digit with typical bone signal, developing near the hypertrophied root of the right corpus cavernosum and the insertion of the right adductor magnus muscle. The MRI also ruled out a cartilage cap, making osteochondroma less likely.

The CT scan confirmed a pelvic digit with a pseudarthrotic single joint on the ischium. It also revealed a focal infiltration of soft tissues surrounding the extremity of the digit, particularly in the hypodermic fat due to a chronic conflict in the sitting position.

The radiologic challenge was to differentiate a pelvic digit from other conditions such as osteochondroma, avulsion-fracture sequelae, ligamentous calcification, and myositis ossificans. The key to distinguishing a pelvic digit from these mimics lies in the lesion's morphology, location, cortical and medullary continuity, and clinical history.

The patient underwent a 2-step surgical resection, and pathologists confirmed the diagnosis of a pelvic digit. The right corpus cavernosum was found to be hypertrophied compared to the contralateral side, possibly due to mechanical constraint by the ossified structure.

This case report presents, according to the authors' knowledge, the first case of an erectile dysfunction caused by a pelvic digit. It serves as a reminder that even seemingly benign bone formations can have significant impacts on a person's health and quality of life.

Fig. 1: Pelvic radiograph revealing a mature and cannulated 2-cm long bony protuberance attached to the right ischiopubic ramus with an articulation at its origin.

Fig. 2: MRI showing an oblong cortico-spongious structure emerging from the antero-inferior margin of the right ischiopubic ramus, with a single joint with the right ischiopubic ramus and an end extending toward the bony insertion of the ipsilateral corpus cavernosum.

Fig. 3: CT confirming the diagnosis of a pelvic digit, in contact with the right ischiopubic ramus, and demonstrating a fully ossified bone with no cartilaginous cap.

Fig. 4: A 2-step surgical procedure was performed with the use of Liston bone-cutting forceps after incising the right adductor aponeurosis.

1. The scientific field of medicine has a new case study to explore, as a farmer's pelvic digit, a rare bone formation, was found to cause both organic erectile dysfunction and severe pain.
2. Pelvic digits, often asymptomatic and discovered incidentally, can have significant impacts on an individual's health and quality of life, as proven by this unique case.
3. In this case, the pelvic digit was causing discomfort while cycling or riding a motorcycle, and worsening pain during sitting and kneeling movements.
4. The diagnosis was confirmed through a series of imaging tests, including radiographs, CT scans, and MRI.
5. The MRI revealed a well-defined cortico-medullary digit with typical bone signal, developing near the hypertrophied root of the right corpus cavernosum.
6. The CT scan confirmed a pelvic digit with a pseudarthrotic single joint on the ischium.
7. The radiologic challenge was to differentiate a pelvic digit from other conditions such as osteochondroma, avulsion-fracture sequelae, ligamentous calcification, and myositis ossificans.
8. The key to distinguishing a pelvic digit from these mimics lies in the lesion's morphology, location, cortical and medullary continuity, and clinical history.
9. The patient underwent a 2-step surgical resection, and pathologists confirmed the diagnosis of a pelvic digit.
10. The right corpus cavernosum was found to be hypertrophied compared to the contralateral side, possibly due to mechanical constraint by the ossified structure.
11. This case report presents, according to the authors' knowledge, the first instance where a pelvic digit was found to cause erectile dysfunction.
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