Chronic osteomyelitis Again seen is heterogeneous signal intensity and enhancement within the subcutaneous fat posterior to the sacrum, favored to represent a combination of edema, scar tissue and heterotopic ossification. There is irregularity of the overlying skin, presumably reflecting ulceration. The signal intensity of the underlying sacrum appears normal and we see no findings to suggest osteomyelitis of the sacrum.Again seen is a deep ulcer along the left gluteal fold extending to the left ischium, which was present on the prior MRI as well as a CT scan from 2014. There is mild deformity and signal abnormality of the adjacent ischium reflecting the sequela of long-standing osteomyelitis. There are no findings to suggest disease progression and the signal abnormality is perhaps slightly less extensive than the prior exam. Heterogeneous signal intensity adjacent to the left ischium presumably represents edema, scar tissue and heterotopic ossification, similar to the prior study.An additional sinus tract is again seen extending from the right gluteal fold to the right ischium, but we see no signal abnormalities to suggest osteomyelitis in this region.Postsurgical changes of a right Girdlestone procedure are again seen. We see no abnormal signal intensity in the proximal right femur to suggest osteomyelitis.Again seen is deformity of the left proximal femur with adjacent heterotopic ossification, which appears unchanged from the prior MRI. Signal abnormality within the left femoral head anteriorly has increased from the prior exam and we suspect this is secondary to progression of osteoarthritis. Heterogeneous signal intensity in the soft tissues surrounding the left hip likely represents scar tissue and additional heterotopic ossification, and appears similar to prior.There is ankylosis of the sacroiliac joints, particularly on the right. There is diffuse muscle atrophy. Again noted is mild edema and enhancement of the gluteal and adductor musculature, but we see no findings to suggest an abscess.
Sequela of chronic left ischial osteomyelitis and other findings as described above with no evidence of progression of disease. Increased signal abnormality within the left femoral head likely reflects progression of osteoarthritis.