67-year-old female with anorectal adenocarcinoma with fistula (invasion into vagina). Baseline scan prior to treatment. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No evidence of lymphadenopathy.BOWEL, MESENTERY: Note is made of linear increased T2 signal abnormality and enhancement at the 12 o'clock position of the anus, which extends anteriorly to the level of the posterior wall of the vagina, consistent with the stated history of an anovaginal fistula (36; series 1901). There is associated increased T2 signal abnormality and enhancement anterior to the anus, interposed between the anus and vagina, however, it is unclear if this represents tumor involvement or inflammatory change. Note is made of asymmetry of the external sphincter along it's left posteroinferior margin, adjacent to the aforementioned signal abnormality. Additionally, the boundaries between the internal and external sphincter are indistinct in this area and tumor involvement cannot be excluded. There is also asymmetrical wall thickening of the anus anteriorly, measuring up to 9 mm in diameter (image 11; series 701). No encapsulated fluid collection to suggest abscess formation.BONES, SOFT TISSUES: Increased T2 signal abnormality along the sacral aspect of the sacroiliac joints bilaterally, most consistent with benign osteitis condensans ilii.OTHER: No significant abnormality noted.
1.Findings consistent with a anovaginal fistula at the 12 o'clock position of the anus, as detailed above. No evidence of abscess formation.2.Wall thickening of the anus with associated enhancing signal abnormality interposed between the anus and vagina, is nonspecific but suspicious for tumor involvement, given the stated history or anorectal carcinoma. There is no evidence of pelvic lymphadenopathy.