Observe the extensive bone deformity present affecting this patient’s left ilium. At first glance one might consider this could be a destructive or expansile neoplasm such as chondrosarcoma, plasmacytoma or possibly metastatic disease. A detailed history of this patient helped answer this question. This patient had a giant cell tumor in the distal tibia that has been treated with a bone graft taken from the patient’s ilium. Without that history it would be very difficult to make that conclusion. Bone grafts are often taken from the posterior aspect of the ilium rather than the anterior surface. While this deformity is quite extensive in this patient, it was asymptomatic.

Also noted were metallic clips present in the proximal scrotum. This patient has had a previous bilateral vasectomy. Note on the lateral film there is multilevel discogenic spondylosis with advanced disc space narrowing at every lumbar segment.

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