Reason: pre-surgical planning. Assess extent of ischial osteomyelitis History: ischial osteomyelitis Again seen is a soft tissue defect extending from the perineal region/upper left thigh to the left ischium. As seen on the recent CT scan, there is destruction of the ischial tuberosity indicating osteomyelitis. There is abnormal signal intensity and enhancement which extends proximally throughout the ischium into the acetabular dome posteriorly. There are nonenhancing foci within the acetabulum which may reflect bone necrosis. Edema is also seen extending anteriorly from the ischium into the inferior pubic ramus on the fat-suppressed T2-weighted images which may reflect extension of osteomyelitis. There is a branching rim-enhancing collection of fluid noted within the obturator internus muscle on the left with a tract extending from this collection along the gluteal musculature posteriorly along the hip joint. There is inflammation of the adjacent soft tissues extending into the adductor musculature of the hip. There is a small left hip joint effusion with synovial enhancement indicating synovitis. We cannot exclude the possibility of a septic arthritis, but we see no edema within the femoral head at this time. There also appears to be a small sinus tract extending from the right ischial tuberosity through the posterior subcutaneous fat to the skin surface, but we see no abnormal signal intensity within the ischium to indicate osteomyelitis on the right. There is an additional sinus tract extending to the right greater trochanter without evidence of osteomyelitis. There is also edema-type signal without enhancement within the musculature of the right hip which may be due to generalized atrophy of the musculature.
1. Multiple decubitus ulcerations as described above with osteomyelitis of the left ischium extending into the acetabular dome posteriorly, and likely into the inferior pubic ramus as well.2. Other findings as described above.