Reason: Patient has metastatic adenoid cystic carcinoma now complaining of right hip pain. Evaluate for bone metastases There is a lesion within the subtrochanteric region of the proximal right femoral diaphysis which demonstrates increased signal abnormality on fluid sensitive sequences and enhances on postcontrast sequences consistent with a focus of osseous metastatic disease, corresponding to the finding seen on recent radiographs. Additionally, note is made of an large enhancing lesion within the right acetabulum which extends into the right inferior and superior pubic rami also consistent with osseous metastatic disease. There is a linear focus of decreased signal abnormality traversing the anterior column of the acetabulum consistent with a pathologic fracture. Additionally, note is made of a linear focus of decreased signal abnormality traversing the right inferior pubic ramus indicating a second pathologic fracture. There is an additional focus of osseous metastatic disease involving the right iliac bone with associated cortical destruction/penetration and extension into the right iliacus and gluteus minimus musculature. There is an additional small round focus of osseous metastatic disease identified within the right iliac bone adjacent to the sacroiliac joint.Additional foci of signal abnormality are identified in the left iliac bone as well as within the lesser trochanter of the left femur, as seen on the large field-of-view images, which are incompletely characterized but are also suspicious for osseous metastatic disease. Severe degenerative disc disease affects image lower lumbar spine. Moderate osteoarthritic changes affect the hips bilaterally. There is a small amount of fluid within the hips without evidence of a large effusion. There is a small amount of peritrochanteric inflammation on the right which is nonspecific.
Osseous metastatic disease affecting the bones of the pelvis and right femur with associated pathologic fractures of the right acetabulum and inferior pubic ramus. Other findings as described above.