Van Neck-Odelberg Disease in a Pediatric Patient With Prolonged Groin Pain: A Case Report.
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Van Neck-Odelberg disease is a benign disorder of the ischiopubic synchondrosis (IPS) that can be mistaken for infection, fracture, or bone tumor. A boy aged 10 years and 7 months presented with a 1-year history of exertional groin pain and intermittent limping. The pain was bilateral but consistently worse on the right and was aggravated by football and running. He was afebrile. Examination showed a mild right antalgic gait, focal tenderness over the right ischiopubic region, and pain on combined right hip flexion and external rotation. The white-cell count (4.9 × 109/L) and erythrocyte sedimentation rate (2 mm/h) were within the reference ranges. A C-reactive protein result was unavailable. Pelvic radiography showed smooth, asymmetric enlargement and central lucency of the right IPS without an aggressive periosteal reaction. MRI confirmed widening of the synchondrosis with surrounding marrow edema. The cortex remained intact, and there was no abscess or soft-tissue mass. A transverse hypointense band perpendicular to the pubic axis represented the characteristic fibrous bridge. The clinical and imaging findings supported a diagnosis of symptomatic Van Neck-Odelberg disease, and biopsy was avoided. Management consisted of acetaminophen as required, activity restriction for 2 weeks, and once-weekly physiotherapy for 6 months with hip adductor and external rotator stretching. Initial improvement in pain and limping occurred at 4-6 weeks, with complete clinical recovery at 6 months. The combination of a 1-year symptom history, bilateral pain with unilateral imaging findings, and a preserved fibrous bridge illustrates how recognition of the typical imaging appearance, together with the clinical and laboratory findings, can prevent unnecessary antibiotics, biopsy, and oncological investigation.