pelvic digits are rare congenital anomalies that develop in soft tissue.(1 - 4 ) there are less than twenty reported cases in the literature .
the majority of reported pelvic digits are asymptomatic and found incidentally during radiography.(2 ) to date , there has never been a report describing a patient with a pelvic digit who presents with a chief complaint of dyspareunia . to the best of our knowledge ,
this is the third reported case of a symptomatic pelvic digit and emphasizes the importance of considering lesions of the bony pelvis in the differential diagnosis of dyspareunia .
a 57-year - old caucasian female presented with a chief complaint of more than one year of dyspareunia .
her past medical history includes chronic bilateral knee , hip and ankle pain and had a right total hip arthroplasty that required multiple revisions .
she had no pain with hip range of motion and her motor and sensory examinations were intact .
review of her radiographs demonstrated a well - positioned right total hip arthroplasty without any evidence of loosening or wear .
however , there was an osseous growth projecting from the inferior aspect of left ischium toward the perineal region .
additional imaging with computed tomography ( ct ) and non contrast magnetic resonance ( mr ) were used to further define the lesion .
representative images , including : a plain radiograph ( figure 1 ) , 3d reconstructed computed tomography ( figue 2 ) and t1 coronal magnetic resonance imaging ( figure 3 ) indicated a bony excrescence from the inferior aspect of the left ischium measuring 1.7 x 1.1 cm .
review of a previous ct scan from 2 years prior to the most recent study , demonstrated a stable lesion .
plain x - ray : ap pelvis demonstrating pelvic digit arising from the left ischium 3d reconstructed computed tomography demonstrating the pelvic digit magnetic resonance imaging demonstrating a pelvic digit the above studies were suggestive of a pelvic digit .
the patient s chief complaint was painful intercourse and she elected to proceed with a resection .
pathology found no evidence of malignancy and the patient was discharged without pain and able to ambulate without support of a walker .
the removed pelvic digit had two bony segments that formed a pseudoarticulartion or joint , visible in images a and b. follow up via a telephone communication indicated that her dyspareunia had resolved .
literature reports have suggested various origins of the pelvic digit , including congenital formation , myositis ossificans , or traumatic avulsion.(1 - 3,5,6 ) in this case , the defining features were that it was well corticated with a pseudoarticulation between bony segments , resembling a digit .
typically this would occur prior to the sixth week of fetal life in the mesynchymal stage.(6,8 ) in most reported cases the pelvic digit is an incidental finding on radiography .
pandey et al . and maegele report the only other cases of symptomatic pelvic digits in a 35 and a 40 year old man , respectively.(6,9 ) these patients both experienced chronic hip pain , tenderness to palpation of the affected region and limited range of motion.(6,9 ) surgical excision was curative for chronic pain and increasing range of motion in both instances.(6,9 ) in summary , pelvic digits are typically incidental findings on imaging studies .
however , in order to facilitate the diagnosis and treatment of pelvic conditions , physicians should be aware that this anomaly can be a source of pain and disability .
 a pelvic digit is a rare congenital anomaly and often an incidental radiographic finding . here 
 we present the first reported case of a 57-year - old caucasian female with a pelvic digit and a chief complaint of dyspareunia . 
 radiographic studies and magnetic resonance imaging confirmed a stable bony excrescence from the inferior left ischium impinging on the pelvic floor . 
 the patient underwent surgical removal of the pelvic digit without complications . 
 accurate diagnosis of pelvic lesions is necessary to guide treatment . 