Lateral view of the sacrum and coccyx reveals an oblique radiolucency in the central aspect of first coccygeal segment. Corresponding vertical lucency can be seen in the AP projection. The sacrum is intact.
The image reveals a coccyx fracture, typically the result of direct trauma and seen most often in elderly, osteoporotic female patients.
Coccyx fractures are rarely diagnosed on pelvic x-rays, as there is a reasonably high false-negative and false-positive rate; small fractures may be missed, and congenital anomalies can look like fractures. When they are diagnosed, a high proportion of the time the treatment remains conservative.
The patient should be referred to an orthopedist for follow-up.
Acknowledgment: Image courtesy of Teleradiology Specialists.

A Female with Coccyx Pain
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