Reason: rule out osteomyelitis of sacral decubitus ulcer There is a decubitus ulcer posterior to the sacrum and coccyx containing low signal intensity presumably representing packing material. The ulcer extends laterally along the posteromedial aspect of the gluteus maximus muscles, left greater than right. The ulcer extends to and beneath the coccyx, and there is signal abnormality within the coccygeal segments, particularly the first and second segments, compatible with osteomyelitis. There is enhancement of the soft tissue surrounding the coccyx and the individual coccygeal bones are poorly defined on the post gadolinium images. There is also enhancement along the lower sacral segments, but the bone marrow signal intensity of the sacrum is preserved. There is mild enhancement of the posteromedial aspects of the gluteus maximus muscles bilaterally where the muscles contact ulcer, compatible with inflammation. Inflammation extends to the perirectal soft tissues, but we see no discrete fluid collection to indicate a soft tissue abscess. There is mild peritrochanteric enhancement bilaterally, but we see no adjacent ulceration or findings to suggest osteomyelitis of the proximal femora. There is edema within the subcutaneous fat along the left flank posteriorly. There is high signal intensity within several muscles of the pelvis and upper thigh, likely representing a combination of inflammation and atrophy, but we see no discrete fluid collection to indicate an abscess.Mild osteoarthritic changes affect both hips. There is a small amount of fluid in the hip joints, but no frank effusions.Foley catheter is noted within the bladder. Mildly enlarged pelvic sidewall lymph nodes bilaterally are likely reactive in etiology.
Decubitus ulcer with findings compatible with osteomyelitis of the coccyx and other findings as described above.