84 year-old woman with history of sacral decubitus ulcers, evaluate for osteomyelitis. SOFT TISSUES: There is soft tissue loss posteriorly compatible with the stated history of sacral decubitus ulcer. We see no abscess.There is edema within the subcutaneous fat of the left buttock. Increased signal intensity on T2 sequences within the gluteal muscles and adductor muscles on the left is nonspecific. Increased signal intensity along the left gluteal medius tendon could represent a myotendinous tear but the tendon itself extends to insert on the greater tuberosity.There is edema within the subcutaneous fat of the right flank. Also, there is increased signal intensity on the T2 sequences in the anterior aspect of the gluteus medius, gluteus minimus, and adductor muscles of the hips perhaps representing additional edema. Also, there is mild edema amidst the anterior musculature of the upper right thigh.Increased signal intensity on both T1 and T2 sequences in the paraspinal muscles likely represents atrophy. BONE MARROW: Adjacent to the sacral decubitus ulcer, there is signal abnormality on both T1 and T2 sequences in the lower half of S5 as well as the upper coccyx consistent with osteomyelitis. Additionally, increased signal intensity is noted on the fat saturated T2 sequence in the lower coccyx and the remainder of S5 with relatively normal signal on T1 sequences suggesting reactive edema. The remaining bone marrow signal intensity is within normal limits without evidence of osteomyelitis.JOINTS: Mild degenerative arthritic changes affect the lower lumbar spine.ADDITIONAL
1.Sacral decubitus ulcer with abnormal signal intensity in the lower sacrum and upper coccyx compatible with osteomyelitis.2.Additional soft tissue inflammation as described above.