Thanks for the several comments….which seem to represent a wide gamut of thoughts!
One person suggested lipoma and found a reported case that looked similar.
A few considered Pagets, but dispensed with the thought given the absence of cortical thickening.
There is marked cortical thinning with modest bone expansion.
A few mentioned possible post RTx change.
I reached the referrer.
I learned that she is demented, in alot of pain, cared for at home by her daughter.
She had TAH/BSO many, many years ago…not history of pelvic radiation.
She had Chemo and Rtx for Breast cancer diagnosed in 2006.
Bariatric surgery.
One person thought the local swelling at and around the fracture site could be sarcoma.
I think her mental status might influence how aggressive they are.
I suggested they could biopsy the tissue at /around the fracture site if it would affect management…or they could get follow up CT in 8-12 weeks to look for fracture healing.
Thanks to everyone who took the time to help.
Hilary
On Fri, May 5, 2023 at 2:21 PM hilary umans <hilary.umans> wrote:
She has widespread foci of fat attenuation with loss of normal trabecular bone throughout the entire left iliac bone
In the supra acetabular region there is sclerosis at the margins of these fat attenuation foci
She has a displaced avulsion of the AIIS, through an area of cortical thinning
The femur and visualized portion of the spine doesn’t look like this
Given the fact that it all measures fat attenuation, there is no neoplasm.
But since the hip and spine look comparatively normal, I don’t think this is metabolic / systemic.
The extent and appearance don’t seem to fit for intraosseous lipoma.
I don’t see findings to suggest hemangioma.
I wonder if end stage Paget and superimposed osteoporosis can look like this.
I can call it severe, localized osteoporosis, but that is difficult to explain.
Before I sign this off, I wonder what you think.
Thank you.
