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So this is a person who presents with left sided low back

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and hip area pain.

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And here's our initial frontal projection

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and again going through our line, uh, checklist.

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In this case, the transfer process are a little bit caught

0:17

off of the top of the field of view.

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We can see a majority of the iliac wings, sacral

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ate lines are maintained.

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SI joints have some mild arthrosis or uh, osteoarthritis,

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but they're not widened.

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There is no diastasis of the pubic synthesis.

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The hip joints show

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that the tear drops are maintained bilaterally.

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Hip joint spaces are fairly well preserved

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and you can see the acetabular roof on the right

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and pretty well on the left.

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If we go through our other pelvic lines, we have our ileal

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pectineal line identified here

0:58

and then our ilio issue line identified here on the right

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as we go to the left ileoanal

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line is preserved.

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Ileo issue line is not visualized.

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And now if we step back

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and look at the two sides compared to each other,

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there is this relative lucency area of rarer faction

1:25

involving the left per acetabular region.

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And that in combination with the loss of

1:32

that ileal issue line should make one very suspicious

1:36

that there's an abnormality residing within that bone.

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As we talked about in the introductory sections,

1:43

it takes about 30 to 50% of bone destruction

1:46

before we can perceive it on radiography.

1:48

So while it's not sensitive to, uh, bone replacing

1:52

abnormalities, it can be specific in particular areas

1:56

and utilizing a checklist approach

1:59

with the lines would allow us to say that

2:01

that left hip is abnormal

2:03

and would warrant further imaging with either CT or MRI.

2:08

So this was initially part of a series of

2:12

lumbar spine series, which included the pelvis.

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So the focus was on the lumbar spine,

2:18

which just showed some mild spondylosis.

2:20

And this finding was not recognized on subsequent imaging.

2:25

We can now appreciate that there is further destruction.

2:30

So now it's more conspicuous that there's an

2:33

destructive expansile process involving

2:36

that left acetabulum.

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So in addition to losing the ileal ischial line,

2:41

there is also thinning

2:43

and a rarefied appearance to the ileal pectineal line

2:48

compared to the right side, again,

2:50

on a fairly well positioned AP radiograph.

2:54

So at this juncture, the abnormality was identified. This

2:59

Exam was targeted at the hip.

3:00

So with a frog leg lateral projection,

3:04

it further demonstrates destructive process involving the

3:07

ACE tablum with some potentially expansile features.

3:10

We have a shell of new bone formation here.

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So at this point, advanced imaging was performed

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and I'll just show you this large field

3:18

of view coronal image including both hip joints

3:21

where we can see a tumor

3:24

situated within the left acetabulum here,

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and as I'm scrolling from this is going from anterior,

3:32

we have the pubic synthesis urinary bladder

3:34

through the main part of the hip joint,

3:37

a fusion here reactive to this neoplastic process

3:41

that's basically replacing, uh, all of that acetabulum.

3:45

And that's why we lose that ileal is issue line.

3:48

So this ended up being a neoplasm.