Name of the Patient : Abc Xyzpant Solmn / M / 75 yrs.
Referred by : Dr. Abc Xyzar.
Examination : M.R.I. of the Pelvis.
CLINICAL PROFILE :
H/O low back pain radiating to the RLE since 6 months.
C/O sudden onset of weakness of the RLE since 8 days.
M.R.I of the pelvis was performed using the following parameters:
7 mm thick T1 Weighted and T2 Weighted (with fat saturation) axial images.
5 mm thick T1 Weighted and STIR coronal images.
5 mm thick Proton density sagittal images.
There is seen an intermediate signal intensity, expansile mass lesion involving the left ischial bone from the level of the acetabulum upto the ischial tuberosity. This lesion appears hyperintense on the T2 Weighted and STIR images. Probable break in the cortex along the medial margin of the left acetabulum is noted with slight medial displacement of the left obturator internus muscle. Probable break in the cortex of the lateral margin of the left acetabulum is also noted with extension of the mass lesion into the left hip joint per se. No abnormally enlarged pelvic lymph nodes are identified.
Small, subcentimeter, focal hypointense lesions on the T1 Weighted images are noted in the visualized femora and in the iliac bones on either side, distal sacrum and in the L4 and L5 vertebral bodies. These lesions also appear hyperintense on the T2 Weighted and STIR images, without break in cortex or soft tissue extension.
Hyperintense signal is seen in the head of the femora bilaterally on the T1 Weighted images and follows fat signal intensity characteristics. Double line sign is noted. This would represent Class A avascular necrosis (Mitchells classification).
The rest of the visualized bones of the pelvis including the proximal femora show spotty fatty marrow changes which suggests osteoporotic changes.
Mild prostatic enlargement is noted.
Expansile lesion in the left ischial bone as described with multiple, smaller, focal lesions in the visualized pelvic bones, proximal femora and the L4 and L5 vertebral bodies and the sacrum as described is not specific for a single etiology. The differential diagnosis would include :
1. Multiple myeloma.
2. Multiple metastases.
3. The left iliac lesion may be a chondrosarcoma with multiple metastases.
Class A avascular necrosis of the femoral heads on either side.