Evaluate right thigh opacity seen on CT. History of psoas abscess status post drainage by IR. History of pancreatic cancer and falling hemoglobin. There is a complex rim-enhancing fluid collection involving much of the quadriceps musculature extending along nearly its entire length with sparing of the rectus femoris. The collection consists of multiple pockets of nonenhancing fluid/tissue that we suspect intercommunicate. Proximally, the collection extends along the posterior margin of the greater trochanter as well as into the adductor musculature of the hip and the iliopsoas muscle. The collection is of heterogeneous signal intensity on T2-weighted images with components that are both hyperintense and isointense relative to skeletal muscle. There is also heterogeneity on T1-weighted images with curvilinear foci of hyperintensity. This heterogeneity raises the possibility of blood products of varying ages and perhaps myonecrosis although we cannot exclude an abscess.There is edema of the adjacent musculature and the surrounding subcutaneous fat. The bone marrow signal is normal without evidence of osteomyelitis. There is a small knee joint effusion. There is no hip joint effusion. A few small inguinal lymph nodes are noted.Note is made of a filling defect in the right femoral vein at the level of the subtrochanteric femur, representing partially occlusive thrombus.
Complex rim-enhancing collection involving much of the quadriceps musculature along its length extending into the adductor musculature of the hip, the iliopsoas muscle, and posterior to the greater trochanter. Heterogeneity of signal on the T1 and T2 images suggests the possibility of blood products of varying ages and possibly myonecrosis but an abscess cannot be excluded.These findings were communicated to Dr. Khattak by telephone at 9:30 AM on 9/28/2016.