The “Dove Drawing” Appearance of the Ilium in Spondyloepiphyseal Dysplasia Congenita: A Proposed Radiographic Sign

Abstract

Recognizable radiographic signs aid in the differential diagnosis of skeletal dysplasias. Spondyloepiphyseal dysplasia congenita (SEDC), a COL2A1-related disorder, presents with characteristic but sometimes subtle pelvic changes in early childhood. To propose a novel pelvic radiographic sign observed in children with SEDC, we reviewed pelvic radiographs of a cohort of molecularly confirmed SEDC patients and noticed that the inferior contour of the ilium forms a continuous line resembling a flying dove, composed of the inner spur (resembling the dove’s beak), formed by the inferior contour of the iliac part of the sciatic notch, sharply angled to the most medial contour of the iliac part of triradiate cartilage, convex line (resembling the dove’s breast) composed of the lateral segment of the triradiate cartilage and medial segment of the acetabulum, and outer spur (resembling the junction between the body and wing) corresponding to the lateral part of the acetabulum and acetabular edge. The “dove drawing” sign may serve as an additional diagnostic clue for recognition of SEDC on pelvic radiographs, especially in children.