Sacral decubitus ulcer The exam is markedly limited by extensive motion artifact, a lack of intravenous gadolinium, and the patient's body habitus.A large decubitus ulcer is seen posterior to the right gluteus maximus muscle with extension to the gluteal cleft. Abnormal signal intensity extends from the ulcer through the subcutaneous fat to the rectum. This abnormal signal intensity may reflect edema and/or scarring but we see no focal fluid collection to suggest abscess in this area.There is no abnormal marrow signal intensity of the sacrum to suggest osteomyelitis. The marrow signal intensity of the upper coccyx also appears normal on T1 sequences arguing against active osteomyelitis. More distally, the coccyx is not seen which may be secondary to chronic erosion from long-standing infection. The bone marrow of the remaining pelvis and proximal femora is unremarkable.There is severe degenerative disc disease of the lower lumbar spine with disc protrusion of L4-L5 and anterolisthesis of L4. There is diffuse subcutaneous edema with combined atrophy and edema of much of the visualized pelvic musculature which is nonspecific in nature. A Foley catheter is noted. There is osteoarthritis of the hips but there are no large hip joint effusions.
Markedly limited exam demonstrates large decubitus ulceration overlying the right gluteus maximus muscle. We see no abnormal signal intensity within the sacrum or proximal coccyx to suggest active osteomyelitis. The lower coccyx is not seen which may reflect chronic erosion from long-standing infection.