ke/sb/nl/rg.
Date : 00.00.00

Name of the Patient : Abc Xyzana Chlmn / F / 42 yrs.
Referred by : Dr. Abc XyzV. Shah.
Examination : M.R.I. of the Left Femur.

CLINICAL PROFILE :

H/O fall in February with injury to the left knee.
C/O pain and swelling over the left knee since then. H/O surgery in left femur at the age of 7-8 years, details not available.

EXAMINATION :

M.R.I of the distal left femur was performed using the following parameters :

4 mm thick T1 Weighted, proton and GRASS sagittal images with fat saturation images.

4 mm thick T1 Weighted and STIR coronal images.

6 mm thick T1 Weighted and T2 Weighted (with fat saturation) GRASS axial images.

OBSERVATION :

There is a fairly large, well-marginated mass lesion in the metaphysis of the distal left femur in the lateral condyle, anteriorly. This lesion measures approximately 2.2 x 2.3 x 1.8 cms. This lesion is slightly hyperintense to muscle on the T1 Weighted images and turns heterogeneously hyperintense on the proton, T2 Weighted, STIR and GRASS images. Few hypointense areas are seen within this lesion on all the pulse sequences which are seen to bloom on the GRASS images and would represent calcification. Subtle hyperintense signal at the periphery in the superior aspect of this lesion on all the pulse sequences would represent altered blood/paramagnetic substance. There is break in the cortex antero-laterally, with extension of the lesion along the anterior margin of the distal left femur. There is surrounding marrow signal change which is seen to extend 7.5 cms cranially from the knee joint. The zone of transition between the marrow signal change and normal marrow is sharp.
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Hyperintense signal is seen anterior to the lower end of femur on the T2 Weighted and STIR images which is slightly hyperintense on the T1 Weighted images and would represent proteinacious fluid.

Hyperintense signal is seen in the adjacent soft tissues from the level of the knee joint for approximately 15 cms cranially suggestive of inflammatory edema.

There is extension of the lesion into the patello-femoral joint and into the knee joint at the level of the intercondylar notch.

The menisci, cruciate ligaments, collateral ligaments and patellar tendons are unremarkable.

Scar of previous surgery is noted along the lateral margin of the distal left femur.

IMPRESSION :

The MRI features are suggestive of a mass lesion in the metaphysis of the distal left femur in the lateral condyle anteriorly measuring approximately 2.2 x 2.3 x 1.8 cms. Surrounding marrow signal change may represent tumor extension/edema. Soft tissue extension and extension into the knee joint and patello-femoral joint of the lesion is as described. This lesion is not specific for a single etiology. The differential diagnosis would include :

a. Giant cell tumor with tumor extension/inflammatory edema, proximally as described.

b. Neoplastic process like sarcoma - less likely.

An infective etiology is also less likely.

The patient is status post-opeartive (details of surgery not available).