This 77 y/o female presented with left hip pain and anemia after a fall. Plain films demonstrated some degenerative osteoarthritic changes but were otherwise unremarkable. An MRI with coronal T1 and fat saturated inversion recovery and axial proton density and fat saturated T2 weighted sequences was performed. Selected images from the MRI scan shown above demonstrate diffuse abnormal marrow signal and abnormal signal in the obturator internus. The abnormal signal in the obturator was felt to be due to muscle strain and was likely the cause of the acute left hip symptoms. Bone marrow biopsy and subsequent consultation with the Hematopathology Department at City of Hope National Medical Center with immunostains and expert morphologic review of peripheral blood and marrow led to the diagnosis of myelodysplastic syndrome.