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weighted fat-suppressed image shows a large effusion and marked edema in the paraarticular muscles (adductor muscle group, iliopsoas muscle, and rectus femoris muscle).

or septic effusion. If there is high clinical suspicion for septic arthritis of the hip, or if MRI demonstrates a joint effusion associated with edema in the paraarticular soft tissues in the absence of trauma or known inflammatory arthritis, aspiration is warranted. Abnormal edema or enhancement of osseous structures in the setting of septic arthritis raises the possibility of concurrent osteomyelitis, but is not indicative of such as this can also reflect a reactive process.70 Bone biopsy in such cases may be necessary to exclude osteomyelitis.


Benign and malignant tumors of the proximal femur, acetabulum sacrum, or innominate bone can present as hip pain. In adults, metastatic disease is the most common tumor associated with the pelvis and hip (Figure 4.23). In younger adults and adolescents, os-teoid osteomas of the femoral neck can manifest clinically as hip pain (Figure 4.24) and can present challenging management issues, particularly if located along the medial femoral neck. Recently, percutaneous radiofrequency treatment71 has been advocated for osteoid osteomas and offers a less invasive alternative to surgical excision of the lesion.

Proliferative Synovitis

Synovial osteochondromatosis and pigmented vil-lonodular synovitis are two proliferative forms of synovitis occasionally encountered in the hip. Synovial osteochondromatosis is an intraarticular condition (typically monarticular) that can be seen from childhood on and is characterized by the development of soft tissue nodules from synovial metaplasia that often calcify or ossify. These nodules often become free intraarticular loose bodies and can extend into neighboring soft tissues including bursa and tendon sheaths. Plain radiographs demonstrate multiple small similar-sized calcified or ossified intraarticular loose bodies. Extension of the process into neighboring bone can result in erosions or cystic lesions. MR demonstrates multiple intraarticu-lar nodules (Figure 4.25). The signal intensity of the nodules is dependent on their composition.72 Non-calcified soft tissue nodules typically demonstrate low signal on T1-weighted images and high signal on T2-weighted images. Calcified nodules typically demonstrate low signal on both T1- and T2-weighted images whereas ossified nodules demonstrate high signal on T1-weighted images.

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FIGURE 4.23. Metastatic lung carcinoma in the proximal right femur. Coronal T1-weighted fat-suppressed image with contrast reveals a heterogenous mass (arrow) epicentered in the cortex and subcortical bone with elevation of the periosteum.

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