44 year old female with perianal Crohn's disease with recurrent fistula. PELVIS:UTERUS, ADNEXA: Note is made of numerous uterine masses with decreased T2 signal abnormality and homogenous enhancement consistent with pedunculated, intramural, and subserosal fibroids. There is focal thickening of the endometrium along the posterior wall of the fundus of the uterus, measuring up to 26 mm in diameter, with associated foci of increased T2 signal abnormality, consistent with adenomyosis.There is nonspecific fluid within the endocervical canal. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Note is made of a linear focus of enhancing increased T2 signal abnormality extending from the 12 o'clock position of the rectum to the posterior wall of the vagina, suspicious for rectovaginal fistula formation. There is an additional focus of enhancing T2 signal abnormality extending from the 7 o'clock position of the rectum to the soft tissue of the right medial thigh consistent with a trans-sphincteric fistula. There is a 8 x 5 mm fluid collection in the surrounding area (26; series 6). Additionally, there is extension of this linear increased T2 signal abnormality to involve the skin surface of the right labia suspicious for enterocutaneous fistula formation. There is an additional 9 x 5 mm fluid collection in in the right labia. There is extensive increased T2 signal abnormality and subcutaneous edema/inflammation in the soft tissues of the right labia and the medial right perineum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is a small amount of free fluid within the pelvis which is nonspecific but may be physiologic.
1.Multiple perianal fistulae including extension to involve the soft tissues of the right perineum, right labia, as well as a probable rectovaginal fistula involving the posterior vaginal wall.2.Numerous uterine fibroids.3.Findings consistent with adenomyosis, most pronounced along the posterior wall of the fundus of the uterus. 