Hi, everybody
This patient came to mri for some old lumbar spine problem (surgery for disk hernia) and for a inguinal “small” lump.
I started with lumbar spine, and by chance, on long localizer I saw a lung tumor (surprise nr 1). Lumbar spine – the usual postoperative, nothing out of the ordinary, nu bone lesions.
I continued the mri exam with the hip and another surprize:
1. huge tumor/ synovitis, with granular aspect similar to rice bodies, AND a polilobular mass anteriorily with some fresh blood inside. The surprise came after iv contrast. The sinovial lining seems perfectly fine, there is no contrast inside the cavity, except for the anterior mass which seems very well dealineated with normal synovium.
Until contrast I was certain it is a tumor.
No I am not so sure. (DWI is also not consistent with malignancy – no restriction on ADCmap)
The anterior part looks like a tumor but could be something else ? A huge thrtombus?
The patient did not have any prior biopsy, so I cannot explain the blood inside the anterior part.
PVMS? does not show any bony erosions
Synovial condromatosis? could be, but how about the anterior part?
Small inguinal adenopathies
2. We did a non contrast CT of the lung to confirm the tumor.
It is quite big, has some air filled bronchi inside, it has malignant appearance BUT it is in contact with oblique fissure and IT DOES NOT DO ANYTHING TO IT. On axial seems to be a little traction but on coronal and sagitall it is simply acollated to fisure, nu mass efect nor traction and no thickening.
Could a tumor do that?
Cryptorgansing pneumonia maybe?
Also, not adenopathies in the hillum or mediastinum
No symptoms from the lung.
Please help me with your opinion!
Can you find some relation between lung and hip, or there pure chance / bad luck?
sorin
lung-and-synovial-tumor.pdf 
Hello, and thank you all for your answers!
To summarize:
1. HIP: almost everybody was in favor of a benign synovial pathology – chondromatosis was the nr 1 diagnosis.
Some opinions where in favor of TB, wich will might be the link between hip and lung, but majority said that it might not be any relation beetween the lesions
2. lung nodule: the opions were divided between malignant tumor and TB. One question was regarding ecchinoccus – I will find out more when serology will come.
As soon as I have more data, I will post them so we might have closure.
Thank you everybody for your time!
Sorin