Bladder Extrophy and Perthes Disease
This is a patient who presented with hip pain and a known congenital defect of the pelvis. Frontal radiograph of the pelvis demonstrates a bladder cathether in place. The red arrows demonstrate marked widening of the pubic symphysis. The green arrows demonstrate sclerosis and fragmentation of the right femoral head. The hip findings are consistent with Legg-Calves-Perthes disease, which is defined as idiopathic avascular necrosis of the femoral head. The second radiograph is a cystogram which demonstrates contrast opacification of the bladder, ureters, and renal collecting systems. A portion of the bladder herniates through the markedly widened pubic symphysis. This patient has a condition known as bladder extrophy, which is congenital defect of the abdominal wall where the pelvic bones do not form or align appropriately. This creates a defect through which the bladder can herniate.