Reason: 62 yo CM presenting with a 1 year history of 1cm subcutaneous nodule of the R buttock, cyst v lipoma v other A marker was placed along the lower aspect of the right buttock near the midline. Deep to this marker is a subcutaneous collection of near-fluid signal intensity on T2-weighted images, that is slightly hyperintense to skeletal muscle on T1-weighted images. There is rim-enhancement following intravenous contrast administration. This subcutaneous collection, deep to the marker, measures approximately 4 x 3 x 1.5 cm. However, there is a "tail" of abnormal signal intensity and enhancement that extends anterior and superior from this collection, through the subcutaneous fat, to the inferior margin of the anal canal, over a length of approximately 7 cm. Although this "tail" does not appear to communicate with the anus itself, these findings are most suggestive of a perianal fistula, with formation of an associated abscess in the posterior inferior right buttock.A nonenhancing collection of fluid signal intensity along the anterior/superior aspect of the right testicle, measuring approximately 2 cm, may represent a cyst, perhaps arising from the epididymis. There is note made of small bilateral hydroceles. Please note the study was not protocoled for detailed evaluation of the pelvic viscera. However, we see no additional abnormalities within the pelvis. The musculature appears normal.Degenerative disk disease affects the lower lumbar spine. Mild osteoarthritis affects both hip joints. A small focus of signal abnormality in the anterior aspect of the right femoral head/neck junction likely represents a benign synovial herniation pit.
1.Findings compatible with a right perianal fistula, with formation of a subcutaneous abscess in the anteromedial aspect of the right buttock, beneath the marker denoting the site of patient's palpable abnormality.2.Other findings, as described above.