57-year-old male. BMT patient on long-term steroid. Severe right hip pain. Evaluate for avascular necrosis R hip. History of metastatic melanoma and myelofibrosis. Slightly mottled appearance to the bone marrow compatible with history of myelofibrosis. We see no specific imaging features of osteonecrosis. Tubular foci of low signal within the iliac wings and right sacrum represent biopsy tracts. Mild osteoarthritis affects both hip joints. Sacroiliac joints are unremarkable. Degenerative disk disease of the lower lumbar spine with spinal canal narrowing, which can be better evaluated with dedicated MRI lumber spine if clinically warranted.Mild edema and enhancement of the lateral insertional fibers of the right gluteus minimus/medius. There is also mild edema and enhancement of the far lateral fibers of the gluteus maximus muscle at the level of the greater trochanter. The right gluteus minimus tendon is slightly thickened but otherwise intact. Mild fatty atrophy of the left inferior erector spinae muscle.Tiny subcentimeter focus of fluid signal intensity adjacent to the anterior rim of the right acetabulum. This could represent a small paralabral cyst. We see no enhancement within either hip joint to indicate synovitis.
1. Bone marrow changes may be related to patient's known history of myelofibrosis. No findings to suggest osteonecrosis.2. Mild nonspecific right peritrochanteric inflammatory changes, as described above.3. Small lobulated fluid signal collection anterior to the right acetabulum, may represent a paralabral cyst. If there is clinical concern for a labral tear, MR arthrography can be considered.