PMC10288649_01
(a) Left hip joint radiograph. Lytic lesion was visualized in the left acetabulum, and the continuity of the local cortical bone was interrupted. Left hip joint CT: (b) Axial soft tissue window. (c) Axial bone window. (d) Coronal contrast-enhanced CT. (e) Axial contrast-enhanced CT. (f) Three-dimensional reconstruction. Osteolytic bone destruction and a soft tissue mass were observed in the left acetabulum. The wall was strengthened and there was a no enhancement liquid low-density shadow in the mass.
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F1
The continuity of the local cortical bone was interrupted, and the adjacent soft tissues were inflamed (Fig. 1a). The average CT value was approximately 44HU (Fig. 1b, c). The wall was strengthened with a CT value of 76HU, and there was a liquid low-density shadow in the mass with a CT value of 23HU, and no enhancement was seen (Fig. 1d, e). Three-dimensional reconstruction showed bone destruction in the left acetabulum (Fig. 1f).
MRI of the left hip joint before treatment. (a) Axial image of T1-weighted image. (b) Axial image of T2-weighted image. (c) Coronal image of T2-weighted image. (d-f) Contrast-enhanced T1-weighted images. MRI showed irregular bone destruction with cortex erosion in the left acetabulum, the abscess showed a low signal intensity on the T1-weighted image and high signal intensity on the T2-weighted image,adjacent bone and soft tissue edema. The abscess wall was strengthened and the pus was not strengthened.
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F2
Magnetic resonance imaging (MRI) showed irregular bone destruction and abscess formation in the left acetabulum, with the abscess measuring 3.6 cm by 1.9 cm by 3.5 cm, cortex erosion and significant bone and soft tissue edema were also observed (Fig. 2a-c). The presence of enhancement at the edge of the lesion and an area of liquefaction necrosis without enhancement in the center indicate abscess formation (Fig. 2d-f).
Histopathological findings of hematoxylin and eosin staining and periodic acid-Schiff's reaction. (a) 200xmagnification, (b) 400xmagnification. Histopathological findings revealed granulomatous inflammation surrounded by a large amount of multinuclear giant cell, some lymphocytes, and plasma cells. (c) 400xmagnification. Periodic acid-Schiff's reaction can saw Cryptococcus.
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Histopathological examination of the specimen showed granulomatous inflammation surrounded by a large number of multinuclear giant cells, some lymphocytes, and plasma cells (Fig. 3a, b), and the presence of Cryptococcus was confirmed by periodic acid-Schiff's reaction (Fig. 3c).
Changes in MRI images after 11 months of antifungal therapy. (a) Axial image of T1-weighted image. (b) Axial image of T2-weighted image. (c) Coronal image of T2-weighted image. MRI showed a reduction in the size of the lesion, but there was still some bone defect in the left acetabulum.
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A follow-up of MRI after 10 months confirmed a decrease in the lesion's size (from 3.6 cm by 1.9 cm by 3.5 cm to approximately 2.7 cm by 1.6 cm by 3.1 cm), but there was still some bone defect in the left acetabulum (Fig. 4).