69-year-old female with a history of sacral decubitus ulcer, worsening pain, evaluate for osteomyelitis. There is a large decubitus ulcer that extends to the lower sacrum and coccyx. There is abnormal signal intensity within the coccyx, highly suggestive of osteomyelitis. There is also suggestion of abnormal signal intensity within the lower sacral segments which may represent osteomyelitis, but this is equivocal. Normal bone marrow signal is preserved in the upper sacral segments. No findings to suggest osteomyelitis of the ilium, ischium or pubic symphysis. The left proximal femur is within normal limits. Evaluation of the right proximal femur is limited by metallic susceptibility artifact due to the patient's prior orthopedic fixation. We see no evidence to suggest osteomyelitis. There is increased signal abnormality within the right femoral head which likely represents avascular necrosis. There is diffuse muscle atrophy. There is diffuse edema within the subcutaneous fat. Note is made of a left lower quadrant colostomy. Degenerative arthritic changes affect the lower lumbar spine and pelvis. There is a Foley catheter within the bladder. There is a small amount of free fluid within the pelvis.
Limited study with findings suggestive of osteomyelitis of the coccyx and possibly the lower sacrum. An addendum can be logged if the patient is able to return for a complete study.