PMC8249124_01
The initial standard anteroposterior radiograph of the patient's pelvis, depicting a lytic lesion (white arrows) at the iliac crest of the right ilium.
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Further investigation with a plain radiograph of the pelvis (Figure 1) and Magnetic Resonance Imaging (MRI) (Figure 2) performed upon her first visit revealed an atypical lytic lesion at the right ilium.
The initial MRI scan of the patient's pelvis. Short TI Inversion Recovery-weighted image sequence (STIR) coronal (a) and axial (b) views. Both pictures demonstrate a lesion with extended bone edema and nonhomogenous appearance, originating from the area of interest along the right iliac crest, combined with extension to the adjacent soft tissue structures (white arrows).
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Further investigation with a plain radiograph of the pelvis (Figure 1) and Magnetic Resonance Imaging (MRI) (Figure 2) performed upon her first visit revealed an atypical lytic lesion at the right ilium.
CT scan of the patient's pelvis (axial view) depicting the CT-guided core needle biopsy of the lesion at the right iliac crest.
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Tomography- (CT-) guided core needle biopsy (Figure 3) with a pathology report negative for malignancy yet nondiagnostic.
MRI scan of the patient's pelvis three months after her initial evaluation. T1-Weighted Image (T1W) coronal view (a), T1W contrast-enhanced coronal view (b), STIR coronal view (c), and T2-Weighted Image (T2W) axial view (d). The lesion appears to have progressed compared with the initial MRI scan evaluation and continues to be characterized by atypical imaging features, edema, and mixed osteolytic and osteoblastic areas (white arrows).
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The patient was given instructions for crutch-assisted partial weight bearing and reevaluation. Three months later, a second MRI scan was performed (Figure 4) and showed further destruction of the right ilium crest, with the presence of extended osteolytic areas.
Contrast-enhanced CT scan of the abdomen (axial view) three months after the initial evaluation of the patient. Notice the existence of a single hydatid cyst with distinct calcified walls, arising from segment II of the left lobe of the liver (white arrows).
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A contrast-enhanced CT scan of the abdomen revealed a 6.4 x 4.5 x 3.3 cm calcified cystic lesion (Figure 5).
CT scan of the pelvis (axial view) of the patient three months after her initial evaluation. Notice the large cystic lesion at the iliac crest, with signs of the destruction of the ilium and areas of calcification (white arrows).
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A CT scan of the pelvis depicted a large cystic lesion at the iliac spine with osseous destruction of the right iliac bone anatomy (Figure 6).
Immediate postoperative anteroposterior radiograph of the patient's hemipelvis, following the curettage of the cyst and the installation of PMMA at the remaining bone cavity (white arrows).
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The remaining bone cavity was filled with the installation of polymethyl methacrylate (PMMA) bone cement (stage 3) in order to prevent the potential development of a postoperative fracture and to prevent the potential relapse of the bone CE (Figure 7).
MRI scan of the patient's pelvis 25 months postoperatively. T1W coronal view (a), T2W coronal views (b, c), T1W axial view (d), and T2W axial view (e). Notice the extended Morel-Lavallee-type cystic lesion at the right gluteal area, with no sign of direct contact with the area where the cystic echinococcosis used to be at the iliac crest.
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An MRI scan (Figure 8) showed a Morel-Lavallee-type lesion located at the ipsilateral gluteal area, although she did not report any injury whatsoever.
CT scanogram of the patient's abdomen and pelvis (a) and CT scan (axial view) of the patient's pelvis (b) depicting the CT-guided insertion of the 14-gauge drainage catheter (gray arrows) into the Morel-Lavallee-type cystic lesion at the right gluteal area.
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CT guidance, a 14-gauge catheter was inserted at the cystic lesion (Figure 9). Culture swabs obtained from the drained fluid came back negative for bone CE recurrence and/or microbial infection.
CT scan of the patient's pelvis (axial view) following the removal of the catheter that was used in order to drain the Morel-Lavallee-type cystic lesion at the right gluteal area, confirming the complete drainage of the cystic lesion.
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The catheter was removed uneventfully, and a subsequent CT scan confirmed the complete drainage of the cyst (Figure 10).