PMC6421802_01
Plain film radiography compares pelvic radiographs from 2010 (a) and 2018 (b). On (a), the presence of moderately severe osteoarthritic change in the right hip is evident. On (b), there is a lytic lesion within the right femoral neck, intertrochanteric region, and proximal femoral metaphysis. Cortical breach with progressive sunburst periosteal reaction is evident.
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Computed tomography, coronal plane, demonstrating a bony lesion affecting the right acetabulum and proximal femur with associated proximal femoral fracture.
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Computed tomography (CT) of the chest, abdomen, and pelvis (Figure 2) confirmed a bony lesion affecting both the right acetabulum and proximal femur with pathological intertrochanteric fracture and abnormal surrounding soft tissue.
Magnetic resonance imaging demonstrating hyperintense marrow replacement, pathological fracture, and extraosseous soft tissue mass.
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Magnetic resonance imaging (MRI) (Figure 3) findings were felt to be consistent with that of a primary bone tumor; tumoral necrosis was evident, and thigh muscles demonstrated oedema to the knee level.
On the nuclear medicine bone scan, avid abnormal uptake is seen in the right acetabulum and proximal right femur, with a central more photopenic area in keeping with the tumor, pathological fracture, and soft tissue lesion.
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fig4
Nuclear medicine scanning (Figure 4) demonstrated avid uptake in the right acetabulum and proximal femur with cortical breakthrough and marked extension to the surrounding thigh compartments but no uptake suggestive of distant disease.