44-year-old female with osteomyelitis presents with fever and discharge. Evaluate for osteomyelitis extension. Again seen is T1 and T2 prolongation involving the left ischium consistent with the history of osteomyelitis, appearing increased when compared to the prior study. There is soft tissue irregularity/ulceration along the posterior aspect of the left hemipelvis which extends to the level of the left inferior pubic ramus overlying the aforementioned area of bone marrow signal abnormality. There is extensive increased signal abnormality on fluid sensitive sequences in the surrounding soft tissue, consistent with inflammatory changes, which extend to the level of the posterolateral aspect of the anus and a enterocutaneous fistula cannot be completely excluded. No focal fluid collection is identified to suggest abscess formation. There is linear increased signal abnormality traversing the left inferior pubic ramus suspicious for a nondisplaced stress fracture. There is mild periosteal reaction in the surrounding area. There is nonspecific subcutaneous edema type signal abnormality involving the left mons pubis, left perineum, left anterolateral thigh and right lateral thigh. There is diffuse fatty atrophy of the musculature of the hips. Again seen are changes consistent with bilateral hip dysplasia with deformity of both femoral heads and the acetabuli. There is a nonspecific lobulated focus of fluid signal intensity along the anterior aspect of the sacrum which may represent inflammatory or postsurgical change, appearing similar to the prior studies. Again seen is a posterior myelomeningocele. Foley catheter in place.
Slight interval increase in findings consistent with acute on chronic osteomyelitis involving the left ischium. Probable nondisplaced stress fracture of the left inferior pubic ramus. No drainable fluid collection is identified. Other findings as described above.