72 year old female patient with severe hip pain, fungemia, elevated CRP/ESR, eosinophilia. Evaluate for PVNS. Please note patient could not tolerate the examination and only T1 weighted coronal and axial fat-suppressed T2-weighted images were obtained, both of which are markedly limited by motion artifact. Given this limitation, the following observations are made:There are erosions of the femoral head and acetabulum as seen on a recent CT scan. There is edema type signal within the femoral neck which may be secondary to the aforementioned erosions. Due to the aforementioned limitations, we cannot tell if there has been progression of erosions compared to the prior CT study. We see no frank fluid within the hip joint. Low signal intensity along the right femoral neck may represent pigmented villonodular synovitis, but could also be seen with amyloid deposition. There is edema within the adductor musculature within the hip, the musculature anterior to the right proximal femur, the right gluteus minimus muscle, and along the right iliopsoas muscle. Edema is noted within the subcutaneous fat. Mild osteoarthritis affects the left hip.
Markedly limited study as described above showing erosive arthropathy of the right hip without frank fluid in the joint, which could represent pigmented villonodular synovitis, amyloidosis, or sequela of chronic inflammatory (including chronic fungal) arthritis. A repeat study following proper patient sedation can be considered.