Reason: Outside Request: pt with bilateral periosteal changes in the distal femurs. ? Of chronic hemorrhages in the bones vs hypertrophic bone. Pt with chronic pain History: Right femur:There is serpentine signal abnormality within the distal femur affecting the diaphysis, metaphysis, and distal diaphysis indicating chronic bone infarction. There is also avascular necrosis of the femoral head. There is a focus of susceptibility artifact within the medial subcutaneous soft tissues of the upper thigh which may represent a foreign body. The musculature of the right thigh appears normal. Aside from mild enhancement of the aforementioned bone infarction, we see no abnormal enhancement.Left femur:There is serpentine signal abnormality within the distal femur affecting the epiphysis, metaphysis and extending to the mid diaphysis. There is also serpentine signal abnormality in the intertrochanteric region and femoral head. There is a small amount of synovial enhancement about the left knee which may represent a mild synovitis, but this is of questionable clinical significance. There is no large joint effusion. The musculature of the left thigh appears normal. Aside from mild enhancement of the bone infarction, we see no abnormal enhancement.
1. Bilateral femoral osteonecrosis.2. Focus of metallic susceptibility in the soft tissues along the medial aspect of the upper thigh may represent a foreign body. This could be further evaluated with dedicated radiographs if clinically warranted.