History of lymphoma in the proximal femur with prophylactic intramedullary rod fixation. Patient presents with pain in the left leg for 2 months. Metallic susceptibility artifact from an intramedullary rod and screw device within the left femur limits evaluation. No evidence of hardware complication is evident. No acute fracture is seen. Heterogeneous bone marrow signal abnormality in the right femoral diaphysis is nonspecific but likely represents residual islands of red marrow. There is a small amount of fluid within the right hip which is not necessarily of any current clinical significance. There is a lobulated focus of fluid signal intensity within the subcutaneous tissue along the lateral aspect of the greater trochanter which may represent a postoperative seroma, although this is incompletely imaged/included in the field-of-view. There is linear decreased signal abnormality within the subcutaneous tissues along the lateral aspect of the subtrochanteric region of the left thigh likely postsurgical in etiology. There is increased bone marrow signal abnormality in the subtrochanteric region of the proximal femoral diaphysis which enhances on postcontrast sequences suspicious for osseous disease which appears decreased in size when compared to the prior MRI hip examination. There is also enhancement of the surrounding soft tissues within the vastus lateralis and intermedius musculature consistent with soft tissue extension of disease which also appears decreased in size when compared to the prior MRI examination of the left hip. There is enhancing increased signal abnormality at the level of the left femoral head/neck junction which likely represents residual osseous disease seen on prior MRI examination, although this is poorly evaluated due to the extensive metallic susceptibility artifact. There is serpentine signal abnormality within the superior aspect of the femoral head consistent with avascular necrosis. Evaluation for subchondral collapse is limited due to the aforementioned metallic susceptibility artifact. Although this examination was not protocoled for detailed evaluation of the knee, there appears to be articular cartilage degeneration along the lateral facet of the patella with degenerative underlying subchondral signal abnormality. The remainder of the imaged musculature is normal in appearance
1. Limited examination demonstrating findings consistent with the patient's known history of osseous lymphoma involving the left femur which appear decreased in size and extent when compared to the prior study, within the confines of this examination.2. Postoperative changes of orthopedic fixation of the left femur without evidence of acute fracture or hardware complication.3. Findings consistent with avascular necrosis of the left femoral head. Other findings as described above.