56-year-old man with history of resolved ischiorectal fossa abscess status post surgical treatment of fistula in August 2015, now with persistent perineal wound. PELVIS:PROSTATE/SEMINAL VESICLES: The prostate and seminal vesicles appear normal.BLADDER: The bladder is normal.LYMPH NODES: Subcentimeter pelvic and bilateral external iliac lymph nodes are noted, probably reactive. There is no significant lymphadenopathy.BOWEL, MESENTERY: The rectosigmoid colon appears normal.BONES, SOFT TISSUES: There is a complex network of sinus tracts and fistulae with multiple branches. The first branch extends from the 1:00 position of the left gluteal cleft (series 8, image 64), courses transsphincteric, and terminates the undersurface of the right penis. The second branch extends from the first (series 8, image 68), courses intersphincteric, and loops around to the right gluteal cleft. A third branch extends from the first (series 8, image 55) and terminates as a sinus tract immediately posterior to the left apex of the prostate (series 8, image 46).Susceptibility artifact in the left lesser trochanter probably related to orthopedic hardware.OTHER: No significant abnormality noted.
Complex network of sinus tracts and fistulae as described above and annotated on key images.