91-year-old female patient with ulceration. Question of osteomyelitis of the coccyx. There is diffuse, heterogeneous signal abnormality of the marrow on the fat-suppressed T2-weighted images as well as heterogeneous enhancement following contrast administration. This is a nonspecific finding, but we cannot exclude a marrow infiltrating process.There is ulceration with edema of the subcutaneous fat posteriorly. There is also generalized edema type signal involving the paraspinal, pelvic, and hip musculature. Ulceration appears to extend to the coccyx, but the signal intensity of the bone marrow on T1-weighted sequences is preserved arguing against osteomyelitis. There is a rim-enhancing fluid collection adjacent to the left ischial tuberosity that we suspect communicates with the skin surface via a sinus tract. Adjacent signal intensity of the bone itself is preserved on T1 weighted images arguing against osteomyelitis.There is a collection of nonenhancing near fluid signal intensity along the posterior aspect of the proximal left femur that measures approximately 6.5 x 2.5 cm in the transverse dimension and appears to communicate with the skin surface. Although we see no specific findings of osteomyelitis of the underlying femur, evaluation is limited due to artifact from the patient's orthopedic hardware. Poorly defined nonenhancing tissue adjacent to the right ischial tuberosity likely represents phlegmon with preservation of underlying bone marrow signal intensity on the T1-weighted images.Incompletely imaged on this study is a fluid collection along the labia, left of midline, which perhaps represents a cyst.A Foley catheter and air is noted within the bladder. There is small amount of free fluid within the pelvis.
1. Soft tissue ulceration and additional soft tissue abnormalities as described above, but we see no convincing imaging findings to suggest osteomyelitis.2. Diffuse heterogeneity of the bone marrow is nonspecific, but could perhaps represent a marrow infiltrating process.