46-year-old male with left buttock wound and fistula status post multiple surgeries. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: A prominent left pelvic sidewall lymph node measures up to 9 mm in short axis, possibly reactive (series 10/32). No pathologically enlarged lymph nodes by size criteria.BOWEL, MESENTERY: There is perianal fistula is present and arises from the posterior 5 o'clock position and extending laterally and inferiorly within the left medial gluteal fold, possibly transsphincteric though evaluation for such is difficult. This fistula has a seton in place. A blind-ending tract from the same fistula is seen extending superiorly into the left ischioanal fossa. No evidence of abscess.BONES, SOFT TISSUES: Somewhat linear low T2 signal with increased enhancement within the the subcutaneous soft tissues of the medial left buttock, most likely related to prior surgical change though mild phlegmon cannot be excluded.OTHER: Small right scrotal hydrocele.
Transsphincteric left perianal fistula as above. Possible mild phlegmon versus surgical change within the subcutaneous soft tissues of the medial left buttock, but no evidence of abscess.