Reason: known large sacral decubitus ulcer, arrived with fever and AMS, r/o OM History: see above There is soft tissue irregularity along the posterior aspect of the coccyx consistent with the stated history of ulceration. The ulceration extends anteriorly to the level of the coccyx. There is increased signal abnormality within the coccyx on fluid sensitive sequences without decrease signal abnormality on T1-weighted images. These findings are most consistent with a reactive osteitis. There is no convincing evidence of osteomyelitis. The remainder of the bone marrow signal is within normal limits. There are foci of signal void within the subcutaneous tissue along the left gluteal crease and left perianal region suspicious for subcutaneous gas density/sinus tract formation. There is apparent extension of increased signal abnormality/inflammation from the level of the ulceration into the presacral space and left perianal area. There is diffuse subcutaneous edema about the pelvis most pronounced posteriorly, which is nonspecific. Some of this edema becomes more confluent, posteriorly, however, there is no encapsulated fluid collection to suggest abscess formation. No enhancing mass lesions are identified. There is increased signal abnormality within the gluteal musculature bilaterally and adductor musculature which is nonspecific, but may represent a myositis. There is a small amount of fluid within both hips, left greater than right, without evidence of a large effusion. There is a small amount of fluid in the right peritrochanteric region which may represent trochanteric bursitis. There is a Foley catheter in place.
1. Soft tissue ulceration with extension anteriorly to involve the perianal and presacral space with associated inflammatory changes. 2. Reactive osteitis of the coccyx. No convincing evidence of osteomyelitis.3. Findings indicating a right trochanteric bursitis.4. Nonspecific inflammatory change within the subcutaneous tissue and gluteal musculature as described above. Other findings as described above.