MR imaging findings in perineal nodular induration (“cyclist´s nodule”): A case report

Cima, Andrea de; Pérez, Nuria Muñoz; Ayala, Gerardo

doi:10.1016/j.radcr.2020.05.006

Cited by 7 publications

(10 citation statements)

References 15 publications

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“…With better awareness, PNI can be diagnosed with a thorough history and physical exam [ 3 , 14 ], avoiding a more expensive workup. In uncertain scenarios where the diagnosis is unclear, advanced imaging can be considered [ 15 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…Ultrasound has an additional advantage in that it can be used to monitor treatment response [ 4 ]. Beyond ultrasound, MRI may be helpful as it provides information regarding lesion extend, as well as PNI features of fibrosis and hypovascularity [ 16 ]. MRI shows irregular hypointense T1 and hyperintense T2 signal in the perineum, just under the ischial tuberosity [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…With PNI, there no invasion of surrounding muscle tissue [ 14 ]. Low intensity signal on diffusion weighted imaging (DWI), with high ADC value consistent with no restricted diffusion is also reported [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

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“Bumpy” ride for the female cyclist: A rare case of perineal nodular induration, the ischial hygroma

Norman

Vitale

2020

International Journal of Surgery Case Reports

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Highlights PNI is a pseudoneoplastic lesion caused by repetitive microtrauma. Shearing in perineal fascia stimulates fibroblastic proliferation. Reported almost exclusively in males, it can occur in females and is underdiagnosed. Cyclists and any saddle sport athletes (even seated lawnmowing) are at risk. Treatment is to remove the trigger; surgery can be considered in refractory cases.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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“Bumpy” ride for the female cyclist: A rare case of perineal nodular induration, the ischial hygroma

Norman

Vitale

2020

International Journal of Surgery Case Reports

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“…Saddle sores are referred to as lesions affecting the skin in the saddle area, which can be acute or chronic [1,[3][4][5]9,10,[13][14][15][16][17][18][19][20][21][22]. Acute phase saddle sores present with chafing of the skin and erythema and are associated with infections such as folliculitis and furunculitis [1,9,13].…”

Section: Definitionmentioning

confidence: 99%

Getting to the Bottom of Saddle Sores: A Scoping Review of the Definition, Prevalence, Management and Prevention of Saddle Sores in Cycling

Napier

Heron

2022

IJERPH

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Objectives: To summarise and map the existing evidence relating to the definition, prevalence, prevention and management of saddle sores within the literature and highlight research gaps. Design: Scoping review. Data Sources: Three databases were searched using an appropriate search strategy agreed on by the authors with the aid of an experienced medical librarian; these databases were MEDLINE, EMBASE and Web of Science. Eligibility Criteria: To be included in this review, studies must have made specific reference to dermatological conditions that affect the saddle area, specifically arising from cycling, in either sex. Results: Seventeen studies were selected for inclusion. Saddle sores in males were the focus of thirteen studies, with only two reporting in females. Saddle sores were defined as connective tissue lesions affecting the skin in the saddle area, which can be both acute and chronic. Commonly cited preventions were chamois cream, high quality, well-fitting cycling equipment and good personal hygiene. Management in the early stages usually involves rest. Topical and intralesional steroids and lubricating creams are recommended treatments for small saddle sores, with surgical excision an option for larger, persistent saddle sores. However, surgery and steroid use may increase risk of recurrence. Conclusions: Saddle sores are an underrepresented, male-dominated issue within the literature. There is particularly limited evidence around treatment options, including topical steroids and surgical removal. Further well-designed observational studies and/or randomised controlled trials will help provide further evidence on prevalence, prevention and treatment available in the future.

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“…34 On ultrasound, PNI may appear as a hypoechoic illdefined mass, without hyper-vascularization at colour Doppler. 38 A magnetic resonance imaging (MRI) scan is a useful imaging modality, with lesions usually appearing hypo-intense on T1-and T2-weighted images. 34,38 The authors have experience of investigating suspected cyclist nodules using an MRI scan (see Figure 3).…”

Section: Effect Of Cycling On Soft-tissue Perineal Lesions ('Cyclist ...mentioning

confidence: 99%

Urological issues in cyclists

Peacock

Cobley

Patel

2020

Journal of Clinical Urology

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Cycle use has grown rapidly over the last few years in the UK. British Cycling membership has increased threefold since the 2012 Olympic and Paralympic Games, and this is likely to rise in the wake of the Coronavirus pandemic. As urologists, day-to-day encounters with cyclists are commonplace, who may present with acute traumatic injuries or chronic overuse injuries. The aim of this literature review was to evaluate the effect of cycling on conditions presenting to the urology clinic, in particular those of raised prostate-specific antigen (PSA), haematuria and soft-tissue lesions (‘cyclist nodules’). Furthermore, the review aimed to summarize the relationship between cycling and pudendal nerve entrapment (PNE) syndromes. A PubMed search of the literature on cycling and genitourinary disorders was performed. The literature suggests no significant change in PSA levels after a bout of cycling. Age appears to have no effect on the change in PSA experienced following a bout of cycling, in particular when comparing those <50 years of age to those >50 years of age. Haematuria appears to be rare with cycling but has been described, even with stationary bike riding. It is imperative to exclude coexisting urinary-tract pathological conditions, and cycling-induced haematuria should always be considered a diagnosis of exclusion. Perineal nodular induration (‘cyclist nodules’) is a rare condition, related to pressure and repetitive micro-trauma between the perineum and saddle. Pudendal Nerve Entrapment (PNE) represents the most common bicycling-associated urogenital complaint. Numbness in the perineum, penis, scrotum or buttocks—‘genital numbness’—is the most common and most recognized symptom of pudendal compression. Despite several studies demonstrating a link between elite cyclists and erectile dysfunction, for the average cyclist riding may actually have a protective effect on sexual function.

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MR imaging findings in perineal nodular induration (“cyclist´s nodule”): A case report

Cited by 7 publications

References 15 publications

“Bumpy” ride for the female cyclist: A rare case of perineal nodular induration, the ischial hygroma

“Bumpy” ride for the female cyclist: A rare case of perineal nodular induration, the ischial hygroma

Getting to the Bottom of Saddle Sores: A Scoping Review of the Definition, Prevalence, Management and Prevention of Saddle Sores in Cycling

Urological issues in cyclists

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