Metastatic lung cancer, worsening pelvic pain There is an expansile mass within the left superior pubic ramus corresponding to an area of known metastatic disease. The mass measures at least 6.1 x 4.5 cm in the greatest transaxial dimensions. Accounting for differences in technique, this appears increased from the prior exam as evidenced by further extension towards the pubic symphysis, greater involvement of the anterior acetabulum, compression of the left femoral vein and extension into the obturator neurovascular bundle. An additional focus of low T1 signal is noted in the left iliac wing which demonstrates enhancement (series 1001, image 31/49) and is suspicious for an additional metastatic focus. Note is also made of a left-sided parasymphyseal fracture.Small focus of increased signal is noted along the right greater trochanter which may represent a component of bursitis. The remaining marrow signal of the pelvis is heterogeneous in nature which may reflect a combination of metaplastic reconversion and posttreatment change.
1. Expansile mass within the left inferior pubic ramus consistent with known metastatic disease. The mass has increased from comparison CT exam and is associated with a parasymphyseal fracture on the left. 2. Enhancing lesion within the left iliac wing is concerning for an additional focus of metastatic disease.