Female 53 years old Reason: r/o osteomyelitis History: chronic left hip ulcer in paraplegic. Bilateral irregular skin defects overlying both hip joints consistent with provided history of skin ulceration with surrounding abnormal enhancement and edema of the soft tissues on the left side. Immediately subjacent to the left skin abnormality there is a 1.3 x 4.2 cm rim enhancing collection of gas which immediately overlies a rim enhancing fluid collection measuring approximately 4.9 x 2.4 cm. This contains a fluid-fluid level. This directly overlies the bone and there is a small localized area of enhancement within the left greater trochanter. There is marked abnormal enhancement and edema predominantly involving the left gluteal musculature extending to the proximal left thigh, consistent with inflammation. There is diffuse muscle atrophy consistent with history of paraplegia.There is a smaller 2.5 x 1.6 cm fluid collection overlying the right greater trochanter without rim enhancement.Air within the urinary bladder, presumably secondary bladder catheterization. Multiple prominent iliac lymph nodes are nonspecific.
1. Fluid collection overlying the left greater trochanter with surrounding inflammatory changes predominantly involving the gluteal muscles and overlying skin ulceration. The appearance is highly suspicious for abscess. Greater trochanter bursitis is felt less likely. Small localized area of enhancement within the underlying left greater trochanter raises the possibility of associated osteomyelitis.2. Nonenhancing fluid collection overlying the right greater trochanter is suggestive of trochanteric bursitis.