Patient with metastatic lung cancer with mets to the right femur, status post chemo and radiation therapy. Please evaluate for change.IMAGE ACQUISITIONS: Contiguous noncontrast axial images of the right hip were obtained using routine protocol with coronal and sagittal reformats There is increased density in the medullary cavity of the mid femoral diaphysis measuring approximately 4 to 5 cm in craniocaudal dimension with endosteal scalloping of the posterior cortex consistent with a metastatic lesion. Please note that the current CT likely underestimates the exact craniocaudal extent of the disease as prior MRI study of 10/6/08 demonstrates the craniocaudad extent of metastases to be approximately 15 to 17 cm. A very thin line of contiguous peripheral cortex remains measuring approximately 1 mm, not significantly changed since prior study. There is stable surrounding ring of periosteal reaction.Aggressive demineralization is noted in the distal femur and around the knee joint.Mild osteoarthritis affects the right hip.
Readministration of metastatic focus to the mid femoral diaphysis with large erosion of the posterior lateral endosteal cortex and very thin residual remnant of cortical bone posteriorly, essentially stable since MRI study of 10/6/08. The patient remains at increased risk for pathologic fracture.