Severe Left Hip Pain Research Articles

MON-337 Peripheral Neurological Complications in Pregnancy- Is Idiopathic Transient Osteoporosis of Pregnancy Concerning?

Idiopathic transient osteoporosis of pregnancy (ITOP) is a rare and under-reported condition that has affected healthy pregnancies. ITOP usually presents in the final trimester of a normal pregnancy. Radiographic studies detect drastic loss of bone mass, elevated rates of turnover in the bone, and edema in the affected portion.We present a 26-year-old previously healthy woman, who was admitted at 39 weeks of gestation with severe left hip pain and inability to walk for one month.The pain was constant, progressive, involving left lower limb, and associated with numbness and weakness. Neurological exam revealed diminished power in the left hip (motor power was 2/5), and inability to stand and walk due to pain in the left hip. She was unable to stand by herself. Investigations revealed anemia, low vitamin B12, low vitamin D and magnesium. Bilateral hip MRI showed increased T2WI signal in the left femoral head consistent with idiopathic transient osteoporosis of the left hip (ITOP). DXA scan showed bone mass density (BMD) below expected for age.The patient had induced vaginal labor without complication. The left hip pain improved after delivery. She was treated conservatively with Calcium, Magnesium and vitamin D. The patient symptoms completely resolved in 3 months post-delivery. DXA scan and Hip MRI at 1 year interval showed normal BMD and complete resolution of previous bone marrow edema and changes seen in MRI hip.This case report serves to highlight the effect of pregnancy on bone mass during third trimester which may result in transient osteoporosis of pregnancy leading to weakness and gait disturbance. Clinical symptoms can be misdiagnosed as a peripheral neurological complications instead of bone metabolism changes of pregnancy.

SAT-338 An Unusual Case of Brown Tumor in the Left Femur Associated with Secondary Hyperparathyroidism

Background: Brown tumor of hyperparathyroidism (BTHPT) are non-neoplastic bony lesions that arise from increased osteoclastic activity in the setting of uncontrolled hyperparathyroidism, (HPT). The prevalence is low, with a frequency of 3% in primary HPT and 2% in secondary HPT. It is rare as earlier detection and treatment of HPT prevents the progression and development of BTHPT. BTHPT is more common when HPT is untreated. BTHPT are benign tumors which usually show high 18Fludeoxyglucose-PET/CT (FDG) uptake. The mechanism of elevated FDG uptake has been suggested to be the presence of giant cells, and intracellular glucose metabolism of the macrophages may also play a role. We describe a case of a patient who presents with FDG uptake-negative BTHPT of the left femur. Clinical Case: 62-year-old male with end-stage renal disease (ESRD) and secondary HPT presented with severe left hip pain for many months. The patient had poor access to health care and had not received routine medical treatments at an outside facility prior to presentation at our facility. Laboratory studies showed PTH 1942 pg/ml (14–72), Calcium 8.7 ng/dl (8.4–10.2), phosphorus 3.6 mg/dl (2.5–4.9), Vitamin D total 19.7 ng/ml (30–140), Vit D 1,25 9 pg/ml (18–72), and creatinine 7.75 mg/dl (.66-1.28), alkaline phosphatase 57 u/L (33–94). FDG scan revealed several lucencies in the left proximal femur, with no uptake. The patient underwent left total hip arthroplasty due to impending pathological fracture. Surgical pathology revealed fragments of fibrous tissue with fibroblasts, hemosiderin and interstitial hemorrhage, consistent with brown tumor. Conclusion: We describe a unique case of BTHPT of the left femur which was the unrecognized cause of hip pain. BTHPT occurs late in the setting of HPT and is considered as a sign of poorly controlled disease. This is the first case of BTHPT to our knowledge that is not FDG-avid. This is unusual given the vascularity seen in these tumors and highlights that glucose utilization may not necessarily reflect the degree of osteoclastic activity in these tumors. Medical treatment has been shown to be sufficient in helping resolve these lesions, although the process is usually slow. Conversely, in cases of refractory disease, subtotal parathyroidectomy may be required. Our case describes an FDG-negative BTHPT, and highlights that although rare, this should be considered in the management of patients with ESRD, secondary HPT and hip pain. Patients can present with various imaging characteristics. Despite being rare, this case underscores the importance of recognition of BTHPT, so that intervention may be rendered early.

Rapidly Progressive Osteolysis and a Large Cystic Lesion that Destroyed the Inner Table of the Iliac Bone Following Cementless Total Hip Arthroplasty: A Case Report.

We report a case of rapidly progressive osteolysis and a very large cystic lesion that destroyed the inner table of the iliac bone following cementless total hip arthroplasty (THA). A 59-year-old female patient developed left hip pain at 11 years after THA. Osteolysis surrounding the acetabular cup was pointed out. She was brought to our hospital by ambulance due to severe left hip pain at 12 years after THA. Computed tomography (CT) showed that a cystic lesion in the pelvic cavity had destroyed the inner table of the iliac bone. Magnetic resonance imaging (MRI) showed a high signal intensity area of the hemorrhagic cystic lesion in the iliac bone in both T1-weighted and T2-weighted images. She underwent a liner and femoral head exchange, and required bone grafting and revision of the cup. The cystic lesion was removed and block-like allograft bone grafts were stuffed into the bone defects. If osteolysis and cystic lesions occur at the same time, not only the bone area around the implant but also a distant area like the inner table of the iliac bone may be destroyed. Additional tests such as CT or MRI may be useful to detect the presence of distant or cystic lesions. Early diagnosis and treatment are important because severe complications may occur in cases where osteolysis and cystic lesions coexist after THA.

62-Year-Old Woman With Acute Hypotension and Hypoxia After Surgical Repair of Hip

Resident in Internal Medicine, Mayo School of Graduate Medical Education, Rochester, MN (C.T.L., Y.N.R.); Advisor to residents and Consultant in Cardiovascular Diseases, Mayo Clinic, Rochester, MN (C.R.B.). A 62-year-old woman presented to the emergency department after a mechanical fall onto her left hip. She had been in her usual state of health earlier that day, but after the fall she experienced intractable leg pain and was unable to bear weight on her left hip. She reported no chest pain, dyspnea, palpitations, light-headedness, or dizziness before the event. Her medical history was notable for hypertension and nicotine and alcohol dependence. Her initial physical examination revealed evidence of severe left hip tenderness and pain with motion. The remainder of her examination findings were unremarkable. Radiography of the left hip revealed a left intertrochanteric hip fracture with minimal displacement. She underwent prompt surgical repair with internal fixation using a cephalomedullary nail. The patient tolerated the procedure well with no complications and minimal blood loss. Postoperatively, she received deep venous thrombosis prophylaxis with subcutaneous heparin. Her pain subsided considerably after the operation. At 36 hours postoperatively, the patient experienced sudden shortness of breath with severe respiratory distress. On examination, she was somnolent and had a blood pressure of 90/54 mm Hg and a heart rate of 131 beats/min. She was tachypneic (respiratory rate, 20 breaths/min) and hypoxic (oxygen saturation, 90% with a face mask delivering 40% fraction of inspired oxygen). The patient was afebrile and drowsy but was able to follow commands. Cardiac examination revealed a right ventricular (RV) precordial heave, elevated jugular venous pressure, and cool extremities with a weakly palpable pulse. Auscultation identified a right-sided third heart sound but no murmurs. Lung examination revealed diffuse bilateral crackles but no decreased breath sounds at the base or dullness to percussion suggestive of a pleural effusion. She had bilateral mild pitting edema on the lower

Searching for the Source: Bacteremia with Marked Cerebrospinal Fluid Pleocytosis

PRESENTATION Serious illness did not impede a 65-year-old woman’s daily activities—until she developed an infection that was difficult to pinpoint. The patient presented with a 1-week history of fatigue and confusion. She had a 20-year history of autoimmune disease and related immunosuppressive therapy, beginning with a diagnosis of seropositive rheumatoid arthritis in the late 1990s. This was associated with Sjogren’s syndrome, confirmed by positive tests for anti-SSA/Ro and anti-SSB/La antibodies. Control of her disease required a series of disease-modifying antirheumatic drugs that, over time, included prednisone, methotrexate, leflunomide, etanercept, rituximab, and abatacept. Five years before admission, the patient had a right axillary mass that was diagnosed as large B cell lymphoma. She was treated with a regimen known as R-CHOP, which consisted of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone. Two years before admission, she reported severe left hip pain, determined to be a consequence of Salmonella septic arthritis. She underwent debridement and intravenous antibiotic therapy, and ultimately, a prosthetic hip was placed. Six months before presentation, she received simeprevir and sofosbuvir for hepatitis C infection. Despite her medical comorbidities, the patient lived alone and took care of her own finances, shopping, and driving. She enjoyed spending time with her grandchildren, and she was highly functional, independently traveling out of town by bus to visit her family 1 month earlier. One week before presentation, she began to experience fatigue so overwhelming that she was falling asleep during the day—even during conversation. This

Vagina–hip fistula after tension-free transobturator tape placement

A 47-year-old woman was referred to our hospital with a 4-week history of severe left hip pain and purulent vaginal discharge. Her medical history was unremarkable except for placement of a TVT-O for stress urinary incontinence 8 years previously. Gynecological examination revealed a fistula on the left vaginal fornix with purulent discharge. The tape was palpable in the depth of the fistulous tract. Gadolinium-enhanced MRI revealed a fistulous tract between the hip joint and the vagina along the course of the transobturator tape. An additional increase in contrast enhancement confirmed the osteomyelitis of the left acetabulum and surrounding inflammation of the adductor and obturator muscles and the iliotibial tract (Fig. 1). The etiopathology of the vagina–hip fistula is unknown. However, the painful motion of the hip occurred after purulent vaginal discharge and could be attributed to coxitis resulting from spread of the original infection to the hip. The TVT-O was removed completely and the surgical treatment of the left hip consisted of irrigation, debridement and drainage. Intraoperative culture was positive

Muscle injury following laparoscopic appendectomy

To the Editor: We describe a rare case of position-related muscle injury in a previously healthy 13-year-old boy (height 155 cm; weight 45 kg) undergoing laparoscopic appendectomy. The surgery was performed in supine position with the patient under general anesthesia and thoracic epidural analgesia. Duration of the laparoscopic procedure was 78 min. Patient positioning was in a head-down position as great as 30 . We carefully monitored the patient’s position to avoid compressing his body. After emerging from anesthesia, he did not complain of surgical site pain or hip pain. However, he complained of severe left hip pain after 6 h. The hip appeared to be swollen and tender. On postoperative day 3, magnetic resonance imaging did not indicate other serious diseases, such as necrotizing fasciitis or rhabdomyolysis (Supplementary Fig. 1). The muscle pain was improved by conservative therapy. Despite full-scale preparations for minimizing risk, position-related muscle injury occurred in a healthy pediatric patient. When a patient is in the head-down position, maintenance of limb perfusion is important to avoid position-related soft tissue injury [1]. Estimating from a simple model in a head-down position of 30 (Supplementary Fig. 2), blood pressure around the hip drops about 1/5.44 9 (height, cm) mmHg compared to that of the head. In pediatric cases, this pressure gradient could have a bad influence on limb perfusion because the normal blood pressure in children is lower than in adults. Additional intermittent measurement of blood pressure at the lower extremity could be effective for monitoring limb perfusion. If blood pressure in the lower extremity cannot be maintained, the anesthesiologist should consider intermittent reversal of the head-down position or limiting the duration of that position.

Another Use of Continuous Transversus Abdominis Plane (TAP) Block in Trauma Patient: Pelvic Ring Fractures

Dear Editor: We would like to respond to the article published by Allcock et al. ⇓ describing the use of continuous transversus abdominis plane (TAP) block for analgesia in major abdominal surgery in a combat surgical environment. We report the successful use of an unconventional indication of this block in two patients who had painful traumatic pelvic ring fractures. The first patient was admitted to the intensive care unit following motor vehicle accidents with a stable pelvic fracture, left acetabular fracture, and right iliac wing and right ischium fractures. Immobilization was indicated. She had a severe left hip pain, 90/100 on the numerical rating scale (NRS). The NRS is a self-report assessment scale for patients using numbers (0 to 100) in order to rate the intensity of their pain. A multimodal analgesia with paracetamol, nefopam, and intravenous patient-controlled analgesia (PCA) with morphine was started. After morphine was administered (20 mg on 4 hours), the patient experienced drowsiness and bradypnea without demonstrable effective analgesia (NRS = 70/100). A left ultrasound-guided …

Aggressive squamous cell carcinoma of the bladder diagnosed in the puerperium

A 27 year old primigravida with a three year history of recurrent urinary tract infections (UTIs) experienced persistent haematuria and UTIs in pregnancy despite prophylactic antibiotics. At 37 weeks she...

Late Hip Arthroplasty Infection Caused byListeria monocytogenesin a Non-Immunocompromised Patient

Prosthetic joint infections caused by Listeria monocytogenes are uncommon. Such infections usually occur in patients with malignant disease, diabetes mellitus, chronic kidney disease, or liver disease or in elderly or immunocompromised patients. We describe a non-immunocompromised 78-year-old male with hip infection caused by L. monocytogenes 11 years after arthroplasty. Eight years postoperatively, revision of the acetabular prosthesis was performed. Two months after that operation, the patient presented with fever, severe left hip pain, inability to bear weight, and painful restriction of left hip motion; the incision site was tender and erythematous. Joint fluid aspirate yielded L. monocytogenes and Staphylococcus epidermidis. Staged revision of the arthroplasty was performed. A gentamicin-loaded polymethylmethacrylate spacer was implanted, and the patient received ampicillin. At the second-stage operation, the cement spacer was removed, and a cement-less total hip arthroplasty was implanted. Postoperative recovery was uneventful, and two years later, the patient has had no joint problems. Predisposing conditions and co-morbidities usually are required for L. monocytogenes infection. Listeria is fastidious and is not a recognized laboratory isolate or hospital contaminant; routine cultures therefore may be negative. In approximately one-half of the reported cases, the prosthetic joint infections were treated successfully by two-stage revision surgery plus long-term antibiotic therapy. In most cases, ampicillin and gentamicin are the first choice. Cephalosporins are rarely effective.

Osteoid osteoma of the femoral head treated by radiofrequency ablation: a case report

IntroductionWe present a case report highlighting the unusual location and atypical imaging characteristics of an osteoid osteoma in the juxta-articular region of the femoral head, and treatment of the condition with radiofrequency ablation. This treatment option is low in both risk and morbidity and is therefore the best option in lesions that are difficult to access surgically because of the risks involved.Case presentationA 40-year-old Indian man from West Bengal presented to our facility with a history of progressively severe left hip pain of insidious onset, requiring analgesics. Imaging with plain radiographs, computed tomography and magnetic resonance imaging confirmed findings of osteoid osteoma in a subarticular location in the femoral head, although imaging features were atypical due to the intra-articular subchondral location.ConclusionRadiofrequency ablation is a newer treatment modality for osteoid osteoma that, being minimally invasive, offers comparable results to surgery with a significantly lower morbidity. To the best of our knowledge, treatment of osteoid osteoma in the foveal region of the femoral head with radiofrequency ablation has not been reported to date. We wish to highlight the successful outcome in our index case using this technique.

Remarkable shrinkage of sarcomatoid renal cell carcinoma with single-agent gemcitabine

A 60-year-old Japanese man presented to our hospital with a painful left hip. Computed tomography showed a tumor in the left kidney and metastases in the left gluteus maximus muscle and lung. The pathological diagnosis of a biopsy specimen obtained from a metastatic lesion in the left gluteus maximus muscle was sarcomatoid renal cell carcinoma. On admission, his general condition was extremely poor. He was confined to bed because of severe left hip pain and confusion, possibly caused by hypercalcemia. This seriously ill patient suffering from advanced sarcomatoid renal cell carcinoma was treated with single-agent gemcitabine, resulting in symptom relief and a dramatic improvement in his status; all of the tumors had regressed significantly by the 11th dose of gemcitabine. These findings indicate that single-agent gemcitabine is one of the few chemotherapeutic agents effective for palliation in patients with sarcomatoid renal cell carcinoma, even those with poor performance status.

Inadvertent self-healing in desperate times

Correspondence to: Dr Sean X Leng, Johns Hopkins University School of Medicine, 5505 Hopkins Bayview Circle, Baltimore, MD 21224, USA sleng@jhmi.edu In February, 2007, a 47-year-old woman was admitted to our hospital, with stage IV pressure ulcers. She had become paraplegic in 1999, after a bullet damaged the spine at the level of the 9th thoracic vertebra. Pressure ulcers developed in 2006. In December, 2006, the patient devel oped a high fever and was found to have worsening pressure ulcers and meticillin-resistant Staphylococcus aureus bacteraemia. Her condition improved with intravenous vancomycin and wound debridement. Because she was doubly incontinent, a Foley catheter was inserted, and a colostomy was done to reduce wound contamination. The patient was transferred to a nursing home, but developed intermittent fever, anorexia, and severe left hip pain. After several weeks, she was transferred to our hospital. On admission, she was cachectic, at 48·2 kg, and had fi ve large stage IV pressure ulcers on the lower back and hips (fi gure). Her white-blood-cell count, and serum concentration of C-reactive protein (CRP) were 14·2×10 per L, and 167 mg/L, respectively. Her serum concentrations of haemoglobin and albumin were only 87 g/L and 19 g/L, respectively. We started to treat her with vancomycin. For wound care, we used an antimicrobial gel. CT showed erosion of the femoral head and neck, inferior pubic ramus, and acetabulum, with fl uid and air in the left hip joint. CT-guided aspiration yielded clear liquid, cultures of which were negative. Despite treatment, the patient’s condition worsened. The hip pain and fever continued; the white-blood-cell count and serum concentration of CRP rose as high as 18·5×10 per L and 257 mg/L, respectively; the serum albumin concen tration fell to 13 g/L, and the patient’s weight to 43·6 kg. 6 weeks after admission, radiography showed that the femoral head and neck were separated from the rest of the femur, and medially displaced. Hours later, a bone fragment fell out of a pressure sore, while the dressing was being changed. The patient’s condition then started to improve. The fever and pain ceased immediately, and the pressure ulcers began to heal. 8 weeks after the fragment fell out, the patient’s weight had increased to 58·2 kg; the serum concentrations of haemoglobin and albumin were 128 g/L and 32 g/L, respectively; the white-blood-cell count and serum concentration of CRP were 8·25×10 per L and 22 mg/L, respectively. At the end of August, 2007, the patient remained in hospital; she had no fever, her weight was stable at 59 kg, and her wounds continued to heal. Pressure ulcers are common in elderly people, and people with spinal-cord injuries. For several years after being shot, our patient had been cared for by relatives and had been able to live at home. When a close relative died, the standard of care provided by her family decreased substantially, and a fragmented health system did not fully meet her needs. We think that the osteomyelitis was caused by infection spreading from an ulcer, either directly or through the bloodstream. The infected proximal femur developed avascular necrosis. Because the blood supply to the proximal femur was so poor, intravenous antibiotics were largely ineff ective. Ordinarily, we would have done an excision arthroplasty, known as the Girdlestone procedure, to remove the infected bone. However, the patient was so ill that surgery was judged to be unaccept ably risky. Fortunately, the necrotic bone dropped off , eerily mimicking the Girdlestone procedure.

診断に苦慮した腰椎外側（椎間孔内）ヘルニアの１例

We present a case of lateral herniation (intraforaminal herniation) which we have trouble in making diagnosis because there is no degenerative change on the responsible disc level. The patient is 47 years old female. April 20th 2003,she felt severe left hip pain and couldn't move. There was a tumor like mass which surround L3 root on MRI. As a result of operation, the tumor like mass turned out not to be tumor but to be lateral disc herniation. We thought it to be a tumor, because there was no degenerative change on L3/4 disc level, so discography and CT discography was not performed. We have second thought that we must perform discography and CT discography case by case.

Shearing of a Peripheral Nerve Catheter

Shearing of a Peripheral Nerve Catheter

Repeated psoas compartment blocks for the management of long-standing hip pain

Background and Objectives: The psoas compartment block is used to produce analgesia of the lumbar plexus mainly for hip and knee surgery. It has also been used for the management of a long-standing pain due to hip joint degeneration. Case Report: A 55-year-old woman with severe left hip pain received repetitive psoas compartment blocks over 18 months. The blocks provided her with effective pain control. The quality and duration of the block was improved by the addition of opioid to the local anesthetic. Conclusion: We successfully performed repeated psoas compartment blocks with a local anesthetic and subsequently with added opioids, which produced substantial pain relief, especially after the addition of opioids. Reg Anesth Pain Med 2001;26:376-378.

HIP DISLOCATION - FOOTBALL

HISTORY - A 9-year-and-6-month-old male football athlete was making a tackle when three opposing players landed on his left leg. He was unsure of his position during the tackle, but experienced immediate and severe left hip pain. He was unable to move his left leg, keeping it in a position of hip and knee flexion. He was taken from the field to the mergency room by EMS. PHYSICAL EXAM - Examination in the emergency room revealed significant left leg pain with the extremity resting in a position of hip flexion, adduction, internal rotation and knee flexion. Pain was localized to the hip. He had no palpable tenderness in the left knee, ankle or foot and no tenderness in his thoracic or lumbar spine. He demonstrated normal sensation through out the extremity and normal motor function distally. DIFFERENTIAL DIAGNOSIS Hip dislocation Hip fracture Pelvic fracture TESTS AND RESULTS EMERGENCY ROOM RADIOGRAPHS Anterior Posterior Pelvis: - skeletally immature individual with dislocation of the left hip. No fractures are seen. Lateral Left Hip: - posterior dislocation of the femoral head with no obvious fracture. CT Scan (Pelvis) - Post Reduction - concentric reduction of left hip. No fracture seen. No fragments in joint. FINAL/WORKING DIAGNOSIS Posterior dislocation of the left hip. TREATMENT IV sedation and closed reduction of the left hip. Post reduction x-rays and CT scan Admitted 23 hrs. for pain control, bedrest, and crutch training. Non weight bearing for 3–6 weeks Gradual return to weight bearing and activities Serial x-rays to evaluate for AVN.

Lesson of the Week: Septic arthritis in osteoarthritic hips

Osteoarthritis of the hip is extremely common and often runs an episodic and deteriorating course. Increased pain in affected patients is usually attributed to an exacerbation of this degenerative process, but this may miss the important development of sepsis in that joint. We have seen four such patients recently. Because of the low index of suspicion, the diagnosis was delayed in all cases. Case 1–A 67 year old woman was admitted to hospital with acute cholecystitis. Her erythrocyte sedimentation rate was 80 mm in the first hour, and her C reactive protein concentration was 19 mg/l. On the ward she complained of pain in her left hip, which was known to be osteoarthritic. This improved and she was discharged home to await cholecystectomy. She presented to the orthopaedic department three months later as an emergency with severe left hip pain; radiographs showed almost complete destruction of the femoral head. Her erythrocyte sedimentation rate was 70 mm in the first hour. An isotope bone scan was consistent with infection. The joint was aspirated under x ray screening, and culture of the fluid grew Staphylococcus aureus. She was treated with high dose intravenous flucloxacillin, but her hip remained painful, preventing mobilisation. Because of the extent of the destruction of the femoral head and the severity of the infection, she …

Aspirin-Induced Hepatic Encephalopathy and Chronic Liver Disease

Letters and Corrections1 September 1980Aspirin-Induced Hepatic Encephalopathy and Chronic Liver DiseaseANDREW I. LAZAROVITS, B.SC., M.D., GEOFFREY M. ROBINSON, M.B., CH.B., PAUL DEVENYI, M.D.ANDREW I. LAZAROVITS, B.SC., M.D.Search for more papers by this author, GEOFFREY M. ROBINSON, M.B., CH.B.Search for more papers by this author, PAUL DEVENYI, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-93-3-510_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: Hepatocellular toxicity secondary to aspirin has been reported (1-4), but to our knowledge the drug has not been implicated as a precipitant of hepatic encephalopathy in adults. We report the case of a patient with chronic alcoholic liver disease who developed hepatic encephalopathy secondary to aspirin toxcity, which was reproduced by a rechallenge experiment.A 56-year-old chronic alcoholic woman with biopsy-proven micronodular cirrhosis was admitted with hepatic encephalopathy. She had been taking approximately 5 g of aspirin per day for severe left hip pain due to progressive osteoarthritis. She had not been drinking ethanol for a month...

Unusual appearance of a chondromyxoid fibroma.

Chondromyxoid fibroma is an uncommon bone tumor that was first described by Jaffe and Lichtenstein in 1948 (1). Because of its infrequency, experience concerning this entity should be shared. Our recent encounter with such a tumor that provoked a degree of surrounding sclerosis not previously illustrated or mentioned in a number of textbooks and articles on bone tumors prompts this single case report. Case Report L. S., a 46-year-old Caucasian male, was admitted to the Nashville Veterans Hospital on Feb. 5, 1968. In 1952 back pain and paresthesia of his left leg had developed. In August 1967 the patient was forced to quit his job as a supervisor in a yarn factory because of increasingly severe left hip pain. Roentgenograms obtained in January 1968 showed a spondylolisthesis of L-5 on S-1 and a 2.5 × 3 cm oval lucency in the left femoral neck which was surrounded by 1 cm of dense bone. This lesion was confined within the base of the neck of the femur and produced no bone expansion (Fig. 1). The patient was shortly thereafter admitted to the hospital. There was some pain on internal rotation of the left hip, and a spondylolisthesis defect was palpable. Physical examination was otherwise normal. The femoral neck was biopsied on Feb. 8, 1968. Cortical and cancellous bone was obtained, and the encountered bone cavity was curetted. Microscopically, this tissue was predominantly fibromyxoid in character (Fig. 2). Pseudolobules were separated by fibrovascular tissue. Small areas showed a chondroid appearance which in places contained focal calcification. The amount of collagen formation and fibrosis present is probably a reflection of the long-standing nature of the lesion. Discussion The usual roentgenographic manifestation of chondromyxoid fibroma is a lesion that is eccentric, lucent, usually expanding, and characteristically showing a well defined, at times scalloped, sclerotic margin (2). In the patient of this report, the lucent area was central within the neck of the femur, did not expand bone, and was surrounded by a thick dense zone of reactive bone. Although chondromyxoid fibroma was included in the differential diagnosis, we felt that the lesion most likely represented a localized area of infection, either low-grade pyogenic or tuberculous. We had never previously encountered this type of roentgenographic appearance in a chondromyxoid fibroma in our clinical experience or in our review of the literature. The type of reaction provoked by such a tumor was especially unusual in view of its location within cancellous bone. Microscopically, the tissue was entirely characteristic of a chondromyxoid fibroma. Summary A case of a chondromyxoid fibroma of the femoral neck is presented that was central, did not produce bone expansion, and provoked an unusually thick dense rim of reactive bone about the central lucency.