Left hip abscess with open wound, evaluate extension of infection Evaluation of the femur is limited secondary to inability to optimally position the patient.Again seen is a large posterior decubitus ulceration of the left buttock/upper thigh appearing similar to the prior exam. The ulceration contains mottled signal abnormality presumably representing packing material. There is extension of a fluid-filled tract from the ulceration to the greater trochanter which contains abnormal signal intensity and enhancement indicating osteomyelitis. This collection also tracks inferiorly into the mid-distal thigh along the semitendinosus, and measures approximately 25 cm in length. A second smaller tract extending inferiorly is seen more laterally along the long head of the biceps. There is mild edema within the adjacent affected musculature.There is generalized atrophy of the hamstring musculature likely reflecting chronic tearing of the hamstring origin. There is edema of additional musculature of the hip and upper thigh with enlargement of the sciatic nerve reflecting inflammation. There is also mild edema affecting the quadriceps musculature, particularly the vastus lateralis.Again seen is a moderate sized left hip effusion with additional inflammatory and arthritic changes previously noted on the pelvis MRI. Multiple enlarged inguinal lymph nodes are present which are likely reactive in nature. Deformity of the left ischium likely reflects longstanding osteomyelitis.
Large decubitus ulceration of the left gluteus and upper thigh with fluid tracking to the greater trochanter and inferior into the mid to distal thigh along the semitendinosus muscle. Abnormal signal intensity within the greater trochanter reflects osteomyelitis.