75-year-old female with severe right hip pain status post fall from couch. History of renal, anal and lung cancer. There is a 3.8 x 3.0 x 7.3 cm focus of nonenhancing increased signal abnormality within the intertrochanteric and subtrochanteric region of the right femur with associated cortical destruction and soft tissue extension resulting in anterior displacement of the vastus musculature, consistent with osseous metastatic disease. Note is made of innumerable additional foci of increased signal abnormality within the bones of the pelvis including the acetabulum bilaterally, inferior pubic rami, superior pubic rami, sacrum, and iliac bones, bilaterally. There is also signal abnormality within the intertrochanteric region of the left femur, distal left femoral metadiaphysis, left femoral head and L5 vertebral body suspicious for osseous metastatic disease. Foley catheter in place. There is increased signal abnormality and fluid sensitive sequences within the right gluteus minimus muscle, anteriorly, as well as along the vastus musculature, which is nonspecific, but does not demonstrate enhancement on postcontrast sequences. There is mild diffuse fatty infiltration of the imaged musculature of the right hip. There is a small collection with fluid signal intensity and fluid fluid level within the soft tissues along the left perineum which may represent a Bartholin's cyst.
Multiple foci of osseous metastatic disease involving the imaged bones of the pelvis and proximal appendicular skeleton as described above. The largest lesion is situated within the intertrochanteric/subtrochanteric region of the right femur and is associated with cortical destruction, soft tissue extension, and involvement of nearly the entire medullary space of the femur. Evaluation for the possibility of an impending pathologic fracture is recommended. Other findings as described above.