Female 37 years old with chronic neurologic condition, found to have sacral decubitus ulcer, assess for osteomyelitis There is ulceration of the soft tissues posterior and distal to the sacrum with signal abnormality extending from the skin to the fifth sacral segment, compatible with an ulcer and surrounding inflammation. Abnormal signal intensity with associated enhancement in the fifth sacral segment and inferior half of the fourth sacral segment is compatible with osteomyelitis. The upper coccyx is not visualized, which may reflect complete destruction due to infection or possibly prior surgery. A portion of the distal coccyx is noted inferior and anterior to S5, with abnormal signal intensity and enhancement suggestive of osteomyelitis.Additional ulceration below the left ischium is seen, with focal signal abnormality within the underlying bone, also suspicious for osteomyelitis.A collection of nonenhancing tissue with surrounding rim enhancement is noted along the right greater trochanter with adjacent soft tissue inflammation. We cannot tell whether this extends to the skin surface. This may represent additional ulceration or bursitis, however we cannot exclude the possibility of an abscess. Mild edema is noted in the underlying greater trochanter on T2 fat saturated images, however the bone marrow signal intensity on T1 images is preserved, suggestive of osteitis rather than osteomyelitis.A small amount of fluid is noted in both hips. The sacroiliac joints appear normal. A Foley catheter is visualized within a distended bladder.
1. Posterior soft tissue ulcers as described above, with osteomyelitis of the sacrum, coccyx, and left ischium.2. Collection of nonenhancing tissue with surrounding rim enhancement along the right greater trochanter, which may represent additional ulceration or bursitis, however we cannot exclude the possibility of an abscess. Signal abnormality in the underlying greater trochanter is suggestive of osteitis rather than osteomyelitis.