67-year-old male with hip pain and concern for metastatic progression in the hips. There are multiple foci of signal abnormality within the bones of the pelvis and proximal femora indicating metastatic disease. Within the left proximal femur, metastatic disease involves the femoral neck and intertrochanteric region with penetration of the lesser trochanter. There is also metastatic disease within the left acetabular dome and anterior column. There is a small hip joint effusion with edema and enhancement in the soft tissues concentrated along the lesser trochanter, likely reflecting tumor extension. The right proximal femur demonstrates metastatic disease within the head, neck, and intertrochanteric region with tumor penetrating the posterior aspect of the femoral head/neck junction as well as the posterior aspect of the proximal femur at the level of the lesser trochanter. There are additional metastatic foci noted within the right acetabular dome. There is edema and enhancement within the soft tissues along the posterior aspect of the lesser trochanter likely reflecting tumor extension into the soft tissues. In addition to multiple additional pelvic bone lesions, and there are multiple lesions within the subcutaneous fat and musculature. Metastatic disease also affects the lower lumbar spine. Degenerative disc disease and facet joint osteoarthritis affects the lower lumbar spine. There are multiple foci of signal void surrounding the patient's neobladder likely reflecting metallic susceptibility artifact from the patient's prior surgery.
Multiple bone and soft tissue metastases as described above with focal areas of penetration of the proximal femora bilaterally. These findings were relayed to Dr. Fletcher at 11:00 AM on 11/4/2015 via text page.