PMC4891470_01
CT-fluoroscopic image showing the biopsy needle (arrow) traversing thick periosteal and endosteal new bone in the subtrochanteric region of the left hip. While there is prominent osteoproliferative change, the borders of the new bone are smooth. The smooth contour and multiple lytic areas suggest the possibility of chronic osteomyelitis. [Powerpoint Slide]
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The patient proceeded directly to computed tomography (CT)-guided biopsy of her proximal femur (Figure 1).
An AP radiograph of the proximal left femur demonstrates a large sclerotic lesion extending from the intertrochanteric region into the proximal diaphysis. [Powerpoint Slide]
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Radiographs demonstrated a large sclerotic lesion in the proximal (Figure 2).
A coronal reformatted CT shows the same prominent, smooth new bone (arrows) involving the proximal femur, as was seen on the radiograph. [Powerpoint Slide]
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An unenhanced CT confirmed the irregular femoral lesion (Figure 3) and identified an additional, similar lesion in the sacrum (Figure 4).
An axial CT image through the mid sacrum demonstrates an additional irregular region of sclerosis and periosteal new bone extending from midline to the right (arrows). [Powerpoint Slide]
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An unenhanced CT confirmed the irregular femoral lesion (Figure 3) and identified an additional, similar lesion in the sacrum (Figure 4).
Coronal T1-weighted (A), coronal T2-weighted fat-suppressed (B), and axial T2-weighted fat-suppressed (C). MR images of the proximal left femur demonstrate prominent periosteal new bone and moderate edema. Extension of the mass into the surrounding soft tissues seen on T2-wieghted images was equivocal for invasion versus mass effect displacing the normal structures. [Powerpoint Slide]
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On magnetic resonance imaging (MRI) (Figure 5), the femoral mass measured 12.6 cm in the cranial-caudal dimension, x 8.1 cm in the anterior-posterior dimension, x 6.3 cm in the medial-lateral dimension.