Perianal pain and history of abscess, evaluate for perianal fistula. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a curvilinear focus of increased signal on diffusion weighted and postcontrast subtraction images extending from the anus at the 6:00 position slightly eccentric to the right which does not have a definite correlate on T2 weighted images and is equivocal for a perianal fistula. No associated perianal drainable fluid collections are identified.BONES, SOFT TISSUES: There is an osseous lesion with thin sclerotic margins within the intertrochanteric region of the right femur (series 6, image 20) which measures 2.5 x 1.5 x 3.9 cm. The lesion demonstrates intermediate T1 signal, increased T2 signal, and does not enhance. The lesion does not appear to have significantly changed in size since 2002 CT. There are small foci of fluid signal within the origin of the left hamstring tendon origin with associated tendon thickening as well as surrounding fluid and enhancement compatible with tendinosis and partial tendon tear. There is also subtle increased fluid signal surrounding the origin of the right hamstring tendon origin compatible with mild tendinosis.OTHER: A nonenhancing subcentimeter soft tissue nodule within the superficial subcutaneous fat of the right labia is nonspecific but may represent a sebaceous cyst. There is an additional nonspecific subcentimeter enhancing nodule within the subcutaneous soft tissues of the left gluteal region.
1.Equivocal perianal fistula at 6:00 position without drainable collection.2.Left greater than right hamstring tendinopathy with partial tendon tear on the left.3.Nonspecific right femoral intertrochanteric osseous lesion. Given imaging features and stability since 2002, favor benign etiology. However, if there is clinical concern for metastatic bone disease, nuclear medicine bone scan could be considered.4.Nonspecific subcentimeter right labial and left gluteal subcutaneous soft tissue nodules, recommend correlation with physical exam, sebaceous cyst formation a differential consideration.