Reason: Eval of OM of pelvis (ischial tuberosity) compared to CT. Establish baseline OM for comparison post abx History: Stage 3 decub ulcer with tracking to the bone. Pt is paraplegic and can't feel the area. There is a 2.2 x 4.6 cm peripherally enhancing fluid collection in the left ischioanal fossa/left posteromedial thigh with a sinus tract extending deep to the ischium, correlating with the abscess described on recent CT. There is extensive inflammation/edema of the adjacent soft tissues. There is a focal area of T1 hypointense, T2 hyperintense marrow signal that also demonstrates enhancement within the posterior aspect of the ischium. There is sclerosis of the left ischium representing chronic changes.An additional T2 hyperintense focus in the left inferior pubic ramus and is related to stress reaction rather than osteomyelitis. There are prominent inguinal lymph nodes bilaterally.
1. Small enhancing focus in the left ischium (adjacent to the tract ) is consistent with acute on chronic osteomyelitis.2. Stress reaction of the left inferior pubic ramus.