64-year-old female with history of metastatic breast cancer and low back pain There is signal abnormality throughout the bones of the pelvis, as well as the lumbar spine and proximal femora compatible with diffuse metastatic breast cancer. The largest lesion involves the left ilium with an associated mildly displaced pathologic fracture which extends into the left SI joint as seen on the prior CT as well as a soft tissue component that invades the gluteal musculature which subjectively appears slightly increased in size compared to the prior CT. There are also pathologic fractures of the superior and inferior pubic rami on the right as well as superior subluxation of the body of the left pubic bone relative to the right, also seen on the prior CT.Within the left proximal femur, tumor appears to penetrate the cortex laterally at the level of the lesser trochanter and posteriorly within the subtrochanteric femur. There is also cortical thinning within the right proximal femur.Please refer to dedicated lumbar spine MRI for findings within the lumbar spine. Increased signal intensity and enhancement of the gluteal musculature on the left may represent denervation atrophy. There is also mild fatty atrophy of the right gluteus minimus. Atrophy of the adductor musculature on the left may also reflect denervation.There is a ventral hernia extending left of midline containing fat and fluid, but we see no definite involvement of bowel. Note is made of small rim-enhancing fluid collections within the sacral foramina which likely represent Tarlov cysts. Heterogeneous marrow enhancement reflects diffuse osseous metastases. Tendinosis of the right hamstrings is seen at their origin. A small amount of fluid is present within both hips, but we see no large joint effusion.
1.Widespread osseous metastatic disease involving the pelvis, proximal femurs and lower lumbar spine, including a pathologic fracture of the left ilium involving the SI joint which was seen on the prior CT as well as chronic obturator ring fractures.2.Tumor within the proximal left femur appears to penetrate the cortex and orthopedic consultation should be considered.