57-year-old female with a deep coccygeal pressure ulcer presenting with sepsis. Evaluate for osteomyelitis. Note is made of soft tissue irregularity along the dorsal aspect of the sacrum consistent with the stated history of ulceration. There is increased signal abnormality within the subcutaneous tissue with associated enhancement on postcontrast sequences extending to the level of the posterior aspect of the sacrum extending laterally along the sacroiliac joints bilaterally. There are multiple foci of signal void along the posterior aspect of the sacrum likely representing foci of gas. Additionally, note is made of increased signal abnormality and fluid sensitive sequences with corresponding decreased signal abnormality on T1-weighted images within the S3 segment of the sacrum indicating osteomyelitis. There is also soft tissue irregularity along the posterior aspect of the left posterior hemipelvis which extends anterior to the level of the hip musculature. Note is made of increased signal abnormality on fluid sensitive sequences within the left iliacus muscle, and vastus musculature of the left hip. There is irregular lobulated enhancement within the soft tissues along the left anterior femoral head/neck junction suggestive of phlegmon formation or early pyomyositis. There is increased bone marrow signal abnormality on fluid sensitive sequences within the left greater trochanter with associated decreased signal abnormality on T1-weighted images indicating osteomyelitis. There is also signal abnormality within the proximal left femoral metadiaphysis which is also suspicious for osteomyelitis. There is no definite drainable collection identified. There is nonspecific subcutaneous edema along the lateral aspect of the thighs bilaterally. Foley catheter in place. There is a small amount of fluid within the left hip joint which may be of no clinical significance.
Soft tissue ulceration with associated osteomyelitis of the left femur and sacrum as described above. Inflammatory changes within the musculature of the left hip with findings suggestive of phlegmon formation/early pyomyositis about the anterior aspect of the left femoral head/neck as described above. No definite drainable collection is identified. Other findings as described above.