Reason: RULE OUT OSTEMOMYLITITS History: BACTEREMIA AND FEVER There is no bone marrow signal abnormality to suggest osteomyelitis. There is no frank osteolysis to suggest osteomyelitis. There is peritrochanteric edema bilaterally, left greater than right. Some of this edema becomes confluent along the lateral aspect of the gluteal musculature which may represent a bursitis. No organized fluid collection is identified to suggest abscess formation. There is enhancing increased signal abnormality within the gluteal musculature bilaterally which is nonspecific but appear to correspond with foci of hypermetabolic activity on recent PET/CT examination. Note is made of enhancing lymphadenopathy in the left internal iliac region measuring 2.9 x 2.7 cm suspicious for metastatic disease. There is also right iliac lymphadenopathy measuring approximately 2.5 cm in its greatest dimension. There is associated enhancement in the surrounding area which extends to the level of the anterior aspect of the L5/S1 disc space appearing similar to the prior studies.
1. Nonspecific edema and foci of enhancement within the gluteal musculature bilaterally which appear to correspond with foci of hypermetabolic activity on recent PET/CT examination. These could represent inflammatory changes related to an infectious etiology in the correct clinical context versus metastatic disease. No drainable fluid collection is identified. No evidence of osteomyelitis. 2. Pelvic lymphadenopathy consistent with the patient's known history of metastatic disease. 3. Findings suggestive of a peritrochanteric bursitis, left greater than right. Other findings as described above.