Male, 43 years old. History of paraplegia with right shin and sacral wound. Evaluate for osteomyelitis. Right tibia/fibula: There is focal skin thickening and mild enhancement along the anterolateral aspect of the leg with mild inflammatory changes of the adjacent subcutaneous fat. There is additional reticulation of the subcutaneous fat particularly anteriorly suggesting mild edema. There is moderate atrophy of the muscles of the leg. There is increased signal intensity of the leg musculature seen on fluid sensitive sequences which may represent atrophy or superimposed edema. Minimal if any enhancement of the musculature is present. We see no fluid collection to suggest an abscess. We see no abnormal signal intensity within the tibia or fibula to suggest osteomyelitis.Pelvis: There is heterogeneous signal intensity with mild enhancement of the subcutaneous fat posterior to the sacrum which likely represents a combination of edema, scar tissue, and heterotopic ossification. There is irregularity of the overlying skin presumably representing ulceration. We see no findings to suggest osteomyelitis of the underlying sacrum.Again seen is a deep ulcer along the left gluteal fold extending to the left ischium which was present on CT study from 2014. There is relatively mild signal abnormality within the ischium which is favored to represent sequela of prior osteomyelitis or perhaps reactive edema. We see no interval bone destruction when compared to prior. Heterogeneous signal adjacent to the left ischium likely represents edema, scar tissue, and heterotopic ossification.There is an additional sinus tract which extends from the right gluteal fold to the right ischium but we see no signal abnormalities to suggest osteomyelitis.Patient has undergone a right Girdlestone procedure. Although the lateral margin of the right greater trochanter is not imaged in its entirety, we see no signal abnormality in the proximal right femur to suggest osteomyelitis.There is a deformity of the left proximal femur with adjacent heterotopic ossification. There is osteoarthritis of the left hip and heterogeneous signal in the surrounding soft tissues which likely represents scar tissue and additional heterotopic ossification.There is ankylosis of the sacroiliac joints, particularly on the right. There is edema within the body of the pubic bones along with the symphysis which is likely degenerative. There is diffuse muscle atrophy. Mild edema and enhancement within the gluteal musculature is present but we see no focal collection to suggest an abscess. There is also increased signal intensity within the adductor muscles of the hips which may represent atrophy or mild edema. There is a Foley within the bladder.
1. Pelvic soft tissue ulcers as described above with imaging features of the sequela of prior osteomyelitis, particularly involving the left ischium, but we see no sacral osteomyelitis.2. Focal ulceration of the anterolateral soft tissue of the right leg with mild inflammation of the subcutaneous fat but we see no osteomyelitis.3. Other findings as above.