Reason: rule out osteomyelitis History: non healing wound There is a large cutaneous defect in the posterior soft tissues of the right upper thigh/buttocks with deep soft tissue ulceration extending between the gluteus maximus and medius muscles and extensive intramuscular granulation tissue. Abnormal T1 hypointense signal and enhancement is seen throughout the bone marrow of the right femur, extending from the femoral neck and greater trochanter and inferiorly 4 cm below the intertrochanteric line. There is no involvement of the right femoral head, acetabulum, or the left hip.There is extensive T2 hyperintense signal and enhancement throughout the musculature of the right leg, with involvement of the gluteus maximize, minimus, and medius muscles as well as the posterior and anterior compartments of the leg and extending beyond the field of view.Additionally, there is a more shallow, broad-based ulceration over the sacrum and coccyx with subtle enhancement of the sacrococcygeal soft tissues and the lower coccygeal segments, concerning for an additional site of osteomyelitis.There is no definite evidence of discrete focal fluid collection or abscess, however there are pockets of air and granulation tissue with peripheral enhancement in the anterior compartment of the thigh, similar to that seen on CT of the pelvis dated 7/28/2016.The neobladder appears distended with an irregular contour, please consider dedicated imaging if clinically indicated.
Findings consistent with osteomyelitis of the right femoral diaphysis and femoral neck with probable involvement of the coccyx.