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Male 66 years old Reason: Right knee x 5 months, no improvement with NSAIDs and injection or therapy. Pain is around patella, evaluate for chondral injury vs meniscus tear History: Right knee pain MENISCI: Both menisci are normal in morphology and signal intensity.ARTICULAR CARTILAGE AND BONE: There is diffuse thinning of the cartilage overlying the medial patellar facet and edema type signal within the superior aspect of the patella. There is no full thickness defect. The medial and lateral joint compartment cartilage is relatively well-preserved.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

1. Chondromalacia of the medial patellar facet cartilage with subchondral edema. No full thickness cartilage defect.2. No evidence of meniscal tear.

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Proximal tibia pain, fever, leukocytosis, elevated ESR/CRP, assess for progression of osteomyelitis Worsening osseous T1 hypointensity signal involving the proximal tibial epiphysis, metaphysis, and diaphysis, with improvement on the the proximal fibular proximal epiphysis and metaphysis. There is also worsening of the associated T2 hyperintensity in these regions. The cortex of the proximal tibial laterally, appears to be disrupted with a subperiosteal fluid collection and peripheral enhancement after administration of contrast (arrows on image 9 on series 2 and image 16 on series 9). These findings are compatible with subperiosteal abscess. There is an increase in right knee joint effusion with associated enhancement of the synovium after administration of contrast rising the possibility of septic joint. More extensive cellulitis and myositis of the right lower leg is noted. Nonspecific bone marrow changes of the proximal third of the tibial diaphysis with lack of contrast-enhancement, may represent early development of intramedullary abscess.

Worsening osteomyelitis with development of subperiosteal abscess of the proximal metaphyses of the right tibia. Right knee septic joint. Worsening in the extension of the cellulitis and myositis.

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Shoulder pain Age-appropriate nonfused growth plate without evidence of associated additional radiographic acute abnormality. If internal derangement is suspected with rotator cuff or laboring, follow-up MRI may be indicated

Normal for age

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Following a discussion of the procedure with the patient and/or family, including its risks, benefits, alternatives and steps to prevent infection, informed written consent was obtained and documented in the patient's chart. The time-out form was completed to confirm patient identity and side/type of procedure. All operators present for the case performed standard preprocedural prep including hand washing, sterile gloves, mask and cap. The patient was prepped and draped in the usual aseptic fashion. Local anesthesia over the target area was obtained by 1% lidocaine. Midazolam and fentanyl were administered IV by the nurses during continuous hemodynamic monitoring. Targeted CT examination demonstrates a 3 cm soft tissue pelvic mass along the anterior aspect of the left ilium which may reside within the left iliacus muscle, corresponding to the findings on recent MRI and PET/CT examinations. Using CT guidance, a 14-gauge Achieve core biopsy needle was advanced into the lesion. 3 14-gauge core needle biopsy specimens were obtained and placed in formalin. Touch preparations were performed and handed to cytopathology to confirm specimen adequacy. 2 biopsy specimens sunk, 1 biopsy specimen floated.The core biopsy specimens were hand carried to the Surgical Pathology lab.The patient tolerated the procedure well without immediate complication. Routine post procedure instructions were communicated to the patient.ESTIMATED BLOOD LOSS: Less than 5cc. An adhesive bandage was placed on the patient’s skin.

CT guided biopsy of left pelvic/iliacus muscle lesion.