Male 44 years old Reason: 44M with h/o fistulizing Crohn's disease, c/b EC fistula from terminal ileum to buttock involving sacrum; please eval for residual fluid collection/pelvic fistula tract History: EC fistula PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: The distal right ureter is dilated and demonstrates mural thickening and hyperenhancement suggestive of inflammation. A right ureteric stent is incompletely imaged and terminates in the bladder.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Again seen is a presacral fluid collection which is stable in size and measures 2.6 x 1.5 cm (series 501, image 60), previously 2.6 x 1.3. There are surrounding inflammatory changes. Diffuse inflammatory changes also surround a fluid tract which extends from the collection inferolaterally across the left hemisacrum, through a left lower sacral foramen, and through the gluteus maximus into the subcutaneous tissues of the left posterolateral pelvic wall. There are inflammatory changes posteromedial to the left sciatic nerve. The fluid collection abuts the posteromedial aspect of the right sciatic nerve.BONES, SOFT TISSUES: The aforementioned collection abuts the sacrum and although this study is not optimized for evaluation of the bone there appears to be some abnormal T2 hyperintense and possibly some subtle T1 hyperintense signal within the sacrum. OTHER: No significant abnormality noted.
1.Presacral space fluid collection consistent with abscess which is unchanged in size compared to prior study.2.Persistent inflammatory changes surrounding the fluid collection with a persistent fistula exiting at the left posterolateral pelvic wall.3.Right hydroureter is incompletely imaged however there is mural thickening and edema suggestive of inflammation. This is nonspecific but may relate to the in situ ureteric stent.4.Signal abnormality within the sacrum immediately subjacent to the aforementioned fluid collection suggestive of chronic osteomyelitis.