Female 54 years old Reason: r/o new bony mets History: new L pelvic/groin pain Again seen is a right sacral soft tissue mass extending inferiorly to the lower sacrum and crossing the midline at S2. The mass encases or at least abuts the S1 through S3 nerve roots. There is fluid within the right sacrum consistent with fracture through this lesion. There is similar signal abnormality in S5, possibly representing an additional myelomatous lesion. The tumor itself is slightly hypointense to muscle on T1 and shows some enhancement following contrast although some portions of the tumor do not show enhancement, possibly related to prior therapy.There is marrow edema in the parasymphysial region which is more suggestive of parasymphysial fractures. There is fluid in the symphysis pubis which is likely secondary to the above described fractures. Degenerative arthritic changes are present.
1. Pathological fracture of the right sacrum. Myelomatous lesion in the sacrum as described above is otherwise not significantly changed compared to prior study.2. Edema in the parasymphysial region and symphysis pubis, likely due to stress fractures, possibly secondary to pelvic instability.