Reason: extend to mid femur; Run as pelvis bone study, patient with hx of T12 paraplegia as child, s/p multiple debridement, with open wound probing to wound along lateral right hip, any sign of new abscess? Extent of osteo or sequestra? History: possible acute on chronic osteo The patient has undergone disarticulation of the right hip. There is a defect traversing the soft tissues from the skin posteriorly to the top of the remaining femur containing fluid and gas. Tracts of fluid extend anteriorly from this defect along the medial and lateral margins of the proximal femur and also superiorly along the proximal end of the remaining femur, where there is additional gas density. There is abnormal signal intensity and enhancement within the proximal femur indicating osteomyelitis. Fluid also extends medially toward a chronically deformed ischium which also shows focal signal abnormality compatible with osteomyelitis. There is extensive inflammation of the surrounding soft tissues.Additionally, there is a large heterogeneous rim-enhancing fluid collection measuring 15.8 x 7.4 x 9.4 cm, more anteriorly within the thigh, extending from the proximal femur laterally to the deformed right pubic bone medially, subjacent to the femoral vessels, compatible with abscess formation. There is abnormal signal intensity within the superior and inferior pubic rami of the right pubic bone compatible with osteomyelitis. This abscess does not clearly communicate with the posterior wound; however, there is a band of intermediate signal intensity extending to the skin surface, anteriorly, that presumably represents sinus tract formation. Once again there is extensive inflammation within the adjacent soft tissues. Additionally, portions of the right femoral vein are not well visualized along the anterior aspect of the abscess suggesting compression.There is chronic appearing deformity of the right iliac wing with signal abnormality that may reflect the sequela of acute on chronic infection. Evaluation of the sacrum is limited by metallic susceptibility artifact related to the patient's orthopedic hardware. Additional ulcerations are identified along the posterolateral aspect of the left hip. One of these ulcerations appears to extend to the level of the greater trochanter of the left femur, but we see no specific imaging features of osteomyelitis affecting the greater trochanter on the left. There is an additional sinus tract which extends inferiorly from the ischial tuberosity to the skin surface with associated deformity and abnormal signal intensity within the left ischium likely representing a combination of acute and chronic osteomyelitis. There is profound atrophy of the musculature of the pelvis and upper thighs. Note is made of a left lower quadrant colostomy. There is a Foley catheter in place within the bladder. Although this examination was not protocoled for detailed evaluation of the pelvic viscera, the bladder wall appears thickened which may represent a cystitis. Note is made of right inguinal and obturator lymphadenopathy which may be reactive.Incompletely imaged on this study is an approximately 3.5 cm mass of low signal intensity just proximal to the aortic bifurcation that likely represents an aneurysm and can be further evaluated with CT angiography.
1. Extensive soft tissue ulceration as well as a large abscess anteriorly within the proximal right thigh with osteomyelitis of the remaining proximal femur and bones of the pelvis as described above.2. 3.5 cm mass of low signal intensity proximal to the aortic bifurcation likely represents aneurysm formation and can be further evaluated with CT angiography.3. Other findings as described above.