An Atypical Hip Pain in a Recreational Athlete: A Case Report.

Osteochondromas are the most common benign bone tumors, but pelvic involvement is rare. We present a case of an iliac osteochondroma manifesting with atypical hip pain, adding to the limited literature on pelvic osteochondromas and highlighting the diagnostic and management challenges of such cases in an athletic population. A 28-year-old male presented with progressive right greater trochanteric area pain, predominantly nocturnal and exacerbated by running and football but absent during cycling. Physical examination and ultrasound revealed no abnormalities. CT and MRI revealed a pedunculated osseous mass arising from the anterosuperior ilium with cortical and medullary continuity, consistent with osteochondroma. MRI demonstrated a thin cartilage cap (< 2 cm) and local irritation of the iliopsoas. Analgesic therapy, sacroiliac joint injection, and physiotherapy failed to provide relief. After discussion in a multidisciplinary oncology board, the patient underwent en bloc excision. Prognosis was considered favorable given the absence of aggressive imaging features. This case emphasizes that nocturnal hip pain and activity-dependent symptom modulation in a recreational athlete are atypical for the far more common musculotendinous causes of hip pain and should prompt clinicians to consider underlying osseous pathology. Further, it illustrates the importance of multimodality imaging in osteochondromas for accurate characterization and supports the role of multidisciplinary tumor boards in guiding management of rare benign bone tumors.