56-year-old female with bilateral hip pain and a sclerotic left hip lesion on CT with a history of lung cancer. There is abnormal signal intensity with the head, neck, and intertrochanteric region of the proximal left femur compatible with metastatic disease, as seen on the recent CT examination. Overall the lesion is multilobulated and is approximately 9 cm in the craniocaudal dimension and is largely isointense to skeletal muscle on T1 weighted images with hypointense components corresponding to sclerosis seen on recent CT examination. The lesion is heterogeneous with hyperintense and hypointense foci on T2-weighted images with heterogeneous enhancement on postcontrast sequences. Penetration of the anterior cortex of the femoral head/neck and intertrochanteric region is visible, but better seen on the recent CT examination. There is mild edema and enhancement of the proximal fibers of the vastus lateralis, but we see no discrete soft tissue mass. There are smaller possible discontinuous lesions noted within the lateral aspect of the intertrochanteric region. The remaining musculature of the left hip is normal. There is a small amount of fluid within the hip joint and perhaps mild enhancement on postcontrast sequences suggesting a mild synovitis. There is a 1 cm focus of intermediate signal intensity within the right acetabular dome with minimal enhancement on postcontrast sequences corresponding to a small focus of sclerosis seen on the recent CT examination, which may represent an additional metastatic focus. There is fluid signal intensity along the left proximal hamstring tendon and sacrotuberous ligament which may reflect small tears, but are not necessarily of any current clinical significance. There is fluid signal intensity along the right hamstring tendons at their insertion suggesting chronic insertional tearing which is not necessarily of current clinical significance. Severe degenerative disc disease affects the lower lumbar spine.
1. Large metastatic lesion involving the head, neck, and intertrochanteric region of the proximal left femur with probable smaller metastatic focus in the right acetabular dome.2. Degenerative disc disease of the lumbar spine and other findings as described above.