Pictorial

Radiologic
Evidence
Woman
or a Man?
Yasuyuki

Kurihara

adiologic

examinations

provide

Kenjirou

frequently

information

about

can

pra#{235}tical
standpoint this information
value, it can be useful in making
preventing

is of limited
a differential

diagnosis

and

especially

when the sex of a patient

careless

mistakes,

men

in the

and women

skeletal

or organ

and

sex differences

of minor

occurrences
changes.

soft-tissue

pathologic

patella

systems

segments.

mon

normal

(Fig.

3). The

of

This

2%

of

and

of

ferences between
pubic

arch

Anteroposterior
this

the pelvic

is the pubic

women

the

significant

difference

and Heinrichs

angle.

Men

and

below

the

abdominal
(Figs.

morphologic

dif-

bones of men

and

that

is, the angle

films

I and

[I] reported,

2).

clearly

The

Department

AJR:167,

October

of Radiology,

St Marianna

1996

more

that

Tohru Ishikawa

is concave

Anatomically,

the

cranial

in the

ridge

stretches

transversely
across
the bladder,
between the
folds on which the ureters open into the bladder. This

ridge

retroureteric

separates

the trigone

fossa,

which

ized as the largest

opacity

study

whom

the

common

in

alized

were men.

the

is visual-

on cystograms.
ridge

interureteric

from

usually

[4], 66 of the

of

angle

sulcus
of the

(also
iliac

called

bone

para-

has

adjacent

and

bones

in women

one

as opposed

four

to only

is occupied
ligaments.

In

77 patients
was

in

well

visu-

iliac
6% of

by fibers

University

intrathoracic

fixed

of

deformity.

This

urography

or excretory

frequently

reveals

of the

interureteric

of the bladder
ridge

cystography

a crescentic

of

in the central

ridge
(Fig.

5).

is visible

Normally,
as a symmetric,

porthe

is characterized

by

configurational

most

encountered
elderly

for

correlates

pulmonary
men
this

commonly
[5]. The

deformity

sagittal
6A and
of the
diameter.

lumi(Fig.

change
with

disease

marked

diameter

apparent

the
has

the characteristic

is readily

strongly

sible

trachea

images,

CT

unique

airway

and

in which

the

the coronal

obstructive

outline

of

is 50% or less of its sagittal

trachea
On axial

Ridge

of

narrowing
and concomitant
of the airway lumen (Figs.

Typically,

6B).

trachea,

portion

coronal
widening

Prevalence

Trachea

saber-sheath

nal narrowing
IV

is

The

in

of

approximately

Saber-Sheath

been

of the pelvis

4). It is a groove

men [3]. The sulcus

the anterior sacroiliac

Sex Differences
in the
Physiologic
Changes

Sulcus)

in

men

after revision March

036i-803X/96/i674-1037

times
[2].

contour

direction.

40-80%

cally

interureteric

tAll authors:

in

of the sacroilradiographi-

tion

AJR1996;167:1037-i040

Eimei Okamoto,

Edlings

in approximately

to the inferior
surface
iac joint
and can be identified

show

wider
in women
than in men
27#{176}
[SD] and 940
26#{176},
respectively).

11, 1996; accepted

for a frac-

mistaken

as a characteristic
(Fig.

significantly

January

be

is noted
is bilateral

sulcus)

(l300

Received

and can
variant

preauricular

glenoid

lnterureteric

As Dihlmann

the pubic

men

of

symphysis.

pubic

or

young

parallel

Pubic Angle

most

two

is a com-

patella
among

Sulcus (Paraglenoid

women

One ofthe

into

smaller
segment
is characterat the superolateral
pole of

cases, and is nine

men than in women

described

Between

Bipartite

patients.

Preauricular

men and women.

Differences

Miyasaka,

in the

or physiologic

This essay illustrates

subtle skeletal
differences seen on radiographs

Anatomic
Women

be divided

variant

located

ture.

Mikiko

Is the Patient

bowed
may

more

the patella

from the persons name. Radiologic

evidence of
sex differences is based on two factors: anatomic
differences

Patella

The

istically

is not clear

Differences:

Ohashi, Azuma Kitagawa,

Bipartite

the sex

of a patient. although
the evidence
be missed
or ignored. Although
from a

often

Yoshiko Kurihara,

of Sex

Essay

6C).
in the

chronic

and

is

in middle-aged
mechanism
is uncertain;

responhow-

19, 1996.
School

of Medicine,

American Roentgen

2-16-1 Sugao,

Miyamae-Ku,

Kawasaki

City, Kanagawa,

Japan

216. Address

correspondence

to V. Kurihara.

Ray Society

1037

Kurihara

Fig. 1.-Anteroposterior
bic arch

below

et al.

radiograph of47-year-old man shows narrow angle of pu-

Fig. 2.-Anteroposterior
caused by pregnancy
dral bones.

symphysis.

ever,

the association

with

chronic

radiograph
of 46-year-old
woman
with osteitis
pubis
reveals wide pubic angle and irregular
sclerosis
in subchon-

obstructive

pulmonary
disease and the restriction
saber-sheath
shape to the intrathoracic

than

of the
por-

tion of the trachea suggest that increases

intrathoracic
pressure deform
the airway.

Prominent

years
4,rY-

old

shows

bipartite

patella

radiograph
(arrow).

are

findings
(Fig.

7).

of

18-year-old

in

Several

19k

of

tracheo-

Calcifications

The

more

than

reports
overall

on

large

prevalence

an overwhelming

lage, differences
exist
women
in the prevalence

between
men
of calcifications

or ossification
of
According to Juriks

laryngeal

frequency

70

among women [6]. In addition

in the tracheobronchial
carti-

the
study

of ossification

Fig. 4.-Anteroposterior
radiograph
of 47-year-old
woman
shows preauricular sulci (small arrows) and osteitis condensans
ilii manifested
as
zones of dense sclerosis within bilateral ilia along sacroiliac
joints (large

in the

anterior

cartilage

(Fig.

8).

of

the

arytenoid

appearance
was

common

the

relatively

in women

patient cohorts
have shown
rates of 0.87-4.
1 %, with
predominance
to differences

man

homogeneous
cartilage
in

especially

thyroid

in 74%

seen
men,

of women

probably

but

because

of

only

severe

cartilage.

the

iti

parts
dense,

Cartilage

calcifications
cartilage

radiographic

Fig. 3.-Anteroposterior

the

calcifications
in the Tracheobronchial

Calcifications

bronchial

-_

in

in women.

of

[7],

the

and
in

cartilage.
degree

are higher

Fig. 5.-IV
interureteric

in

and
men

in the Lower

pattern

costal

cartilage

graphic

Costa! Cartilage

of calcifications
is
with

finding

in the lower

well-known

radio-

difference.

sex

Women

usually

in

lower

costal

cartilage

(Fig.

men

exhibit

marginal

calcifica-

the

whereas
lions

(Fig.

women
take

have

10).

usually
the

form

central

Central
are

of

Marginal

men

sometimes

are

addition

to these

urogram of 51-year-old
man shows
ridge in central portion of bladder

but

seen

unique

in

occasionally

of small

OW

nodules.

9).

calcifications

solid

solid

calcifications

circles

in

unilaterally.

In

patterns.

crescentic
(arrows).

or

calcifications

diffuse,

outline

of

arrows).

1038

AJR:167,

October

1996

Radiologic

Evidence

of Sex

Differences

Fig. 6.-Saber-sheath
trachea in 70-year-old man with chronic obstructive
pulmonary
disease.
A and B, Frontal (A) and lateral (B) radiographs
of chest show coronal
narrowing
of intrathoracic
C, CT scan shows saber-sheath
shape of trachea.

Fig. 7.-Chest

radiograph
calcifications

prominent

portion

of trachea

(arrows).

4).

spontaneously.

of 80-year-old
woman shows
in tracheobronchial
cartilage.

Fig. 8.-Lateral view of soft tissue of neck in 39-yearold man shows inhomogeneous
ossification of entire
anterior portion of thyroid cartilage
(arrows); this finding is characteristic

total,

bilateral

cartilage
Such

of men.

calcifications

frequently

a finding

are

usually

of
seen

occurs

the costal

iliac

(Fig.

usually

in the

I I).
thorax

of a woman.

not

side
affect

found

wonien
Osteitis

Condensans

Osteitis

of dense

AJR:167,

l!ii

condensans

sclerosis

cies.
ilii

within

October 1996

appears

the ilium

as a zone

along

the

of the

sacroiliac

is bilateral
the

joint

Thus.

relate to the
and delivery.

joint

have
the

and

This

condition

space.

in

had one
cause

of

(Fig.

symmetric

exclusively

almost
who

and

the

condition

change

because

is infrequent

this type of sclerotic

in older

women.

is
Parietal

childbearing

or more

It

does

may

abnormal
stress
of pregnancy
This lesioti probably
resolves

Thinning

As in other

pregnan-

fuse

osteoporosis.
tion

portions

rarefaction
to

of

of the
bone.

skeleton,

so-called

dif-

senile

may occur in the skull. In addi-

rarefaction,

bone

absorption

in

the

1039

Kurihara

et al.

Fig. 9.-Radiograph
of lower ribs in 58-year-old wornan shows calcifications
in central
portion
of lower
costal cartilage (arrow); this finding is characteristic
of women.

Ii

,,,

f#{149}
S

Fig. 10.-Radiograph
of lower ribs in 71-year-old
man
shows calcifications
in margins of lower costal cartilage (arrows); this finding is characteristic
of men.

10

1-11-

Fig. 11.-Anteroposterior
cartilage;

radiograph
of 68-year-old
frequently
is noted in elderly

this finding

calvarium,

UlOst

protilinent

the parietal
hones.
hone resorption-which
the

outer

the

entire

the

characteristic

tahle
sive

postulated
parietal

1040

cati
uiay
diploic

the

of

Such

).

in wonien.

prohahly

nien.
that

hones

Steinhach

the

localized

combined

otily

skull-results
of

the

It is niuch
thinning
w ith

diffuse,

total,

bilateral

calcifications

Fig. 12.-Anteroposterior

in costal

osteoblastic

activity

lack

of stress

hones

are

without

in

are

not

and
the

only

nmscular

could
strain,

caused

by

the

parietal

parts

of

attachment

to nuscular

subject

he
because

the
and

less

Ohata

I 8)

of
decreased

the

relation
t,e,!str

2. Lason
variants

of

Dcc

PM.

4.

calvarium

Edling
ridge

therefore

NP.

5. Grncne

tension.

the third

kind:

r1teauren1ent

and sex in adults.

1992: 156:42()-124
tO

iLge

Eoii.olii

results

in

Rii,it-

JR (linically
significant
radiologic
ilflaU)flhIC
of the ,kckton.
.%.IR 1994: 163:249-255

preauricular

Further

sulcus.

pulmonary

SM.

Stark

cartilage

caleitIcations

I 1liorw

I,,,ai,i,it

7. Junk

AG.

laryngeal

5. Steinhach
thinning

studies
Ada

Radiology

the

P. Jacobson
iii

interureteric

1948:30:69-75

trachea:
disea.c. AiR

n,Iation

to chnnic

1978:130:441-145
F. Tracheohronchial

dii

inpatient

population.

1995: 10:22()-222

Ossification
skeleton.

of
Radial

R. Siher-sheath

obstnictive

roeiitienorn-

V. Pelvine

The

of the bladder.

6. Bravo

I . Dihln#{236}annV\V. Hciitrichs
ctr

3.

of 77-year-old
marked thinning

shows

1981:140:354

References
of

radiograph

with parietal thinning

of parietal bones (arrows).

woman

inner

is a result

and

shows

or

is progres-

resorption

osteoporosis.

in

the region
of
be seen. This
involve
either
space

appearance
I2

postmenopausal
cOtlltllOtl

the

thickness

( Fig.
and.

and

table

iti

also

woman
women.

and

calcification
1984:25:

/1(1(1 Radial

HF. Ohata
of the pirietil

\VG.

The

hones.

.tJR

of

the

I7-22

significance

of

1957:78:39-45

AJR:167, October

1996