55-year-old female with ischial and sacral wounds concern for osteoarthritis. There is ulceration of the soft tissue posterior to the lower sacrum and coccyx with an overlying bandage. Low signal intensity within the defect upon all sequences presumably reflects air trapped beneath the bandage. This presumed gas density extends to within 4 mm of the coccyx with signal abnormality interposed between the ulcer and bone likely representing inflamed tissue. The gas-filled ulcer extends into the subcutaneous fat distal to the coccyx, terminating into a small rim-enhancing fluid collection. There is edema and enhancement of the adjacent soft tissues reflecting inflammation.The marrow signal intensity of the sacrum is normal without evidence of osteomyelitis. There is mild increased signal intensity of the marrow of the coccyx on the fat suppressed T2 weighted images. The signal intensity of the majority of the coccyx on T1 weighted images is preserved, suggesting reactive osteitis rather than osteomyelitis. The very tip of the coccyx, however, is slightly indistinct and we cannot exclude the possibility of early osteomyelitis at this location. The signal intensity of the ischia is normal without evidence of osteomyelitis. We see no specific findings of osteomyelitis affecting the remainder of the pelvis. There is a small amount of fluid in both sacroiliac joints with mild enhancement of the right sacroiliac joint. These findings may reflect mild sacroiliitis, but we see no adjacent abscess or sinus tract to suggest a septic arthritis. Mild osteoarthritis affects both hips. There is diffuse atrophy of the musculature of the pelvis and upper thighs. There is a Foley catheter in the bladder.
1.Soft tissue decubitus ulceration as described above. 2.We see no findings to suggest osteomyelitis of the sacrum or ischia. There is abnormal signal intensity within the majority of the coccyx on T2 weighted images with preservation of signal on T1 weighted images, suggesting reactive osteitis rather than osteomyelitis. The distal tip of the coccyx is indistinct, and while this could conceivably reflect early osteomyelitis, this is equivocal. 3.Other findings as above.