16-year-old male with pilonidal disease; non-healing, non-surgical wound; status post wound vac. Evaluate for possible osteomyelitis/foreign body/track PELVIS:PROSTATE/SEMINAL VESICLES: The prostate and seminal vesicles are normal.BLADDER: Bladder is normal.LYMPH NODES: No lymphadenopathy is noted.BOWEL, MESENTERY: As described below, there is extension of inflammatory changes within the posterior soft tissues anteriorly to the anus suspicious for a fistulous tract. No significant anal wall thickening is noted and the remainder of the imaged bowel is normal.BONES, SOFT TISSUES: Subcutaneous edema and stranding noted within the midline posterior subcutaneous soft tissues overlying the sacrococcygeal region extending to the skin surface consistent with pilonidal sinus disease. Within this inflammatory process in the deep subcutaneous soft tissues is a more discrete cystic collection measuring 2.9 cm x 1.5 cm x 3.4 cm (series 4, image 58 and series 8, image 25) demonstrating heterogeneous enhancement. This process involves the gluteal cleft with extension of the inflammatory changes anteriorly to the anus (series 4, image 40) suspicious for a fistulous tract without significant anal wall thickening. These changes also extend adjacent to the sacrum, however bone marrow signal is normal. OTHER: No significant abnormality noted.
Findings compatible with pilonidal sinus disease within the posterior soft tissues overlying the sacrococcygeal region complicated by phlegmonous changes without discrete abscess formation. There is suspicion for a fistulous communication to the anus. No abnormal bone marrow signal is noted to suggest osteomyelitis.