Reason: Hx of metastatic colon cancer with lower back pain and bilateral hip pain History: lower back pain and bilateral hip pain There is extensive subcutaneous edema which shows little, if any, enhancement following gadolinium administration. This edema extends distally into both proximal thighs off of the field of view of this study. There is nonenhancing fluid signal intensity between the ischia and gluteus maximus musculature, bilaterally, likely reflecting confluent edema. There is also nonspecific edema of the adductor musculature of the hips and to a lesser degree the gluteal musculature, but we see no discrete rim-enhancing fluid collection to suggest abscess formation in the pelvis or proximal thighs. We see no focal bone marrow lesions. There does appear to be enhancement of the residual red marrow within the pelvis and proximal femora. There is metallic susceptibility artifact along the periphery of the rectosigmoid colon that has the appearance of suture material. Posterior to the suture line is an irregularly marginated enhancing nodular mass which demonstrates intermediate signal intensity on T1 and T2-weighted images, measuring approximately 2.5 cm in its greatest diameter, which could represent neoplasm. There is a Foley catheter within the bladder. There is free fluid within the pelvis which appears increased when compared to the prior CT examination.Although the psoas musculature is not completely imaged, there is edema and enlargement of the right psoas musculature with what appears to be a central area of nonenhancement that associated with peripheral rim enhancement, best seen on the sagittal postcontrast T1-weighted images. We cannot exclude the possibility of a psoas abscess or hematoma. Again seen is thrombus within the left common iliac vein extending into the IVC. There is a small fat-containing right inguinal hernia.There is no evidence of synovitis of the hips or sacroiliac joints. Moderate degenerative disc disease affects the level of L2/L3. Mild degenerative disc disease affects the level of L3/L4. There is susceptibility artifact within the subcutaneous tissues of the lower back which may represent suture material.
1. Extensive subcutaneous edema and additional nonspecific edema of the adductor musculature of the hips and to a lesser degree the gluteal musculature. Additionally, the right psoas muscle appears enlarged with heterogeneous signal intensity and enhancement that extends off of the field of view of this study. We cannot exclude the possibility of a psoas abscess or hematoma. This could be further evaluated with a contrast-enhanced CT examination of the abdomen and pelvis if clinically warranted.2. Enhancing mass posterior to the rectosigmoid colon at the site of surgical suture material may represent neoplasm.3. Interval increase in free fluid within the pelvis. Other findings as described above. These findings and recommendation were discussed with Dr. Ganjoo by phone at 1:00 PM on 6/15/2016.