69-year-old male with acute hip pain and leukocytosis, evaluate for septic hip There is enhancing reticulation along the anterolateral subcutaneous fat of the pelvis, hip and upper thigh indicating inflammation. There is edema and heterogeneous enhancement of the gluteus medius muscle containing branching nonenhancing foci seen on the small field of view post contrast images of the right hip. This process extends superiorly off the field of view on these images, but the edema seen within the muscle on the large field-of-view images extends to the muscle origin. The posterior fibers of the gluteus medius muscle are relatively spared. As seen on the prior CT, there is crescentic edema/fluid deep to the tensor fascia lata and iliotibial band and superficial to the vastus lateralis muscle which extends inferiorly off the field-of-view of this study. This edema/fluid extends posteriorly along the greater trochanter and deep to the gluteus maximus muscle. There is also edema and mild enhancement of the adductor musculature of the hip and perhaps a tiny focal collection without rim enhancement along the posterior aspect of the adductor brevis, which may represent confluent edema. There is also minimal edema of the contralateral adductor musculature at the pubic origin. Bone marrow signal intensity is within normal limits without findings to suggest osteomyelitis. Facet arthropathy affects the lower lumbar spine. There is no joint effusion or findings to suggest synovitis of the hips or sacroiliac joints.
Edema and heterogeneous enhancement of the gluteus medius muscle is nonspecific but could represent pyomyositis. There is also confluent edema/fluid seen on the large field-of-view images extending inferiorly down the lateral aspect of the thigh, deep to the iliotibial band with additional inflammatory changes as described above. No discrete drainable fluid collections are present. The possibility of infection, including necrotizing fasciitis, cannot be excluded on the basis of this study. Please note that the postcontrast images of this exam are limited to a small field-of-view centered at the hip and if further imaging is clinically warranted, the patient may return for additional postcontrast images with extended coverage (we attempted to have the patient called back for further imaging, but we were notified that the patient was on his way to surgery).