Wk 2, Case 4 - Review

Patient History
66-yo female with right lateral hip and groin pain for 3 months.

Findings
SKELETAL: Moderate osseous edema, with both T1 and T2 signal change, in the right femoral head and neck. T2 hypointense irregular lines in the neck are associated with stress microtrabecular fracture/insufficiency microfracture. No unstable fracture or macrofracture. No articular surface involvement.

No infiltrative or destructive bone lesion.

PELVIS: Colonic diverticulosis. Incompletely included cystic lesion within the left hemipelvis measuring up to 6 cm, though only partly included at the study periphery.

JOINTS: High grade right femoroacetabular arthropathy including joint space loss, osteochondral erosions, acetabular marrow reaction and pseudocysts, acetabular labral fraying and anterolateral tear. No AVN. Moderate right hip effusion. No loose body. Normal symphysis pubis. Normal right SI joint as included.

ACETABULUM/LABRUM: Anterolateral acetabular labral fraying and tearing. Acetabular spurring laterally.

MUSCLES/TENDONS/LIGAMENTS: Normal iliopsoas. Normal gluteus medius and minimus insertions. Normal hamstring origin. No ischiofemoral impingement.

OTHER/SOFT TISSUE: The pelvic and extrapelvic musculature is normal.

Conclusion
1. Insufficiency stress reaction and stress microfracturing of the medial right femoral neck, without unstable fracture. No cortical step-off or gap. No AVN.
2. Moderate to severe right femoroacetabular arthropathy including joint space loss, erosions, marrow reaction, spurs and labral tearing. Moderate right hip effusion.
3. Indeterminate cystic lesion in the left hemipelvis, only partly included at the study periphery, formal evaluation recommended.
4. Colonic diverticulosis.