41-year-old female intravenous drug user with left hip fracture, febrile despite antibiotics. There is enhancement of the left hip joint indicating synovitis with small nonenhancing pockets representing small collections of fluid. There is a 2.0 x 2.0 x 0.8 cm collection of fluid along the anterosuperior aspect of the hip joint capsule, which possibly communicates with the underlying joint. There is edema and enhancement of the surrounding soft tissues of the hip extending into the proximal thigh musculature and off the field of view of this study. There is also edema and enhancement of the acetabulum and femoral head. There is loss of hip joint cartilage superiorly. There is flattening and fragmentation of the superior aspect of the femoral head, which is better seen on the recent CT scan. These findings are compatible with septic arthritis and adjacent osteomyelitis of the femoral head and acetabulum. Intramedullary edema and enhancement also extends to the femoral neck and intertrochanteric region to a lesser degree. The right hip, sacroiliac joints and pubic symphysis appear normal. Degenerative disc disease affects the lower lumbar spine. There is minimal peritrochanteric edema and enhancement on the right and mild enhancement of the obturator internus on the right, which is nonspecific. There is a Foley catheter within the bladder.
1.Synovitis of the left hip with small pockets of fluid compatible with septic arthritis.2.Extensive inflammatory changes in the soft tissues with a small collection of fluid along the anterosuperior aspect of the hip joint, which may represent a small abscess.3.Abnormal signal in the femoral head and acetabulum compatible with osteomyelitis.