88-year-old female with a sacral decubitus ulcer. Evaluate for osteomyelitis. Metallic susceptibility artifact from the patient's right total hip arthroplasty device limits evaluation of the right hip. Note is made of soft tissue irregularity along the posterior aspect of the sacrum and coccyx consistent with the known history of ulceration. There is an enhancing sinus tract which extends anteriorly from the aforementioned ulceration to the level of the coccyx. There are multiple foci of signal void in the surrounding area consistent with foci of gas. There is increased signal abnormality on fluid sensitive sequences within the surrounding subcutaneous tissues. There is increased signal abnormality on fluid sensitive sequences within the coccyx with associated decreased signal abnormality on T1-weighted sequences consistent with osteomyelitis. There is associated enhancement on postcontrast sequences. There is enhancing signal abnormality in the presacral space suggestive of phlegmon formation. No focal fluid collection is identified to suggest abscess formation.There is nonspecific subcutaneous edema along the lateral aspect of the thighs and peritrochanteric region, bilaterally. There is increased signal abnormality within the gluteal musculature and abductor musculature on the left which is nonspecific. There is nonspecific increased signal abnormality within the left iliacus muscle on fluid sensitive sequences. There is enhancement of the left gluteus maximus muscle belly and postcontrast sequences. Foley catheter in place.
1. Findings consistent with sacral decubitus ulcer with osteomyelitis of the coccyx as described above. Enhancing signal abnormality in the presacral space suggestive of phlegmon formation. No focal fluid collection is identified to suggest a drainable abscess.2. Nonspecific subcutaneous edema about the lateral aspect of the hips as well as nonspecific increased signal abnormality within the left iliacus, gluteal and abductor musculature. Superimposed infection cannot be excluded.