71-year-old male patient with sacral decubitus ulcer. Evaluate for osteomyelitis. There is ulceration of the soft tissues posterior and inferior to the coccyx. The enhancing rim of the ulcer appears to contact the distal coccygeal segment. There is mild edema-type signal within the distal coccyx on the T2-weighted images with preservation of marrow signal intensity on T1-weighted images. These findings are more compatible with reactive osteitis than osteomyelitis. Bone marrow signal in the sacrum appears normal. Mild edema within the ischia bilaterally likely reflects adjacent tendinosis of the hamstring origins.There is bilateral edema type signal and mild enhancement of the adductor musculature of the hips, iliac muscles bilaterally, and gluteal muscles bilaterally which is nonspecific but may reflect a myositis. There is also reticulation of subcutaneous fat indicating edema. There is minimal if any fluid within the hip joints. There is poorly defined signal abnormality and enhancement within the right femoral head and neck that we suspect is degenerative in etiology. The soft tissues immediately surrounding the hips show relative lack of enhancement following gadolinium administration with enhancement peripherally, but we are uncertain of the etiology of this pattern as we see no drainable fluid collection. It is possible that this could represent tissue necrosis. Foci of increased signal intensity are noted on the nonenhanced T1-weighted fat-suppressed sequence deep to the left iliotibial band which may reflect small hematomas.Degenerative disc disease affects the lower lumbar spine. The prostate gland is enlarged.
1. Decubitus ulcer with findings suggestive of reactive osteitis of the distal coccyx rather than osteomyelitis.2. Edema and enhancement of the musculature of the pelvis with peculiar relative nonenhancement of the juxta-articular soft tissues of uncertain etiology. This may in part reflect a myositis, possibly with regions of myonecrosis. We see no drainable fluid collection.3. Abnormal signal intensity and enhancement of the right hip which we suspect is degenerative.4. Degenerative disc disease of the lumbar spine.