Date : 00.00.00
Name of the Patient : Abc Xyzi Thanalmn / F / 33 yrs.
Referred by : Dr. Abc Xyzrani.
Examination : M.R.I. of the Pelvis.
CLINICAL PROFILE :
C/O backache radiating to the LLE since February 0000.
H/O abscess drainage from lumbar region on 00.00.00.
M.R.I of the pelvis was performed using the following parameters:
5 mm thick T1 Weighted sagittal images.
10 mm thick T1 Weighted and T2 Weighted (with fat saturation) axial images.
7 mm thick T1 Weighted and STIR coronal images.
There is an ill-defined hypointense signal on the T1 Weighted images involving the S1, S2 and S3 sacral segments. This lesion appears hyperintense on the T2 Weighted and STIR images. There is however, no obvious involvement of the sacro-iliac joints per se.
There is seen a fairly large, well-marginated, hypointense lesion (when compared to normal muscle) on the T1 Weighted images in the left gluteal region, extending from the level of the sacro-sciatic notch, upto the level of the ischial tuberosity. This lesion appears significantly hyperintense on the T2 Weighted and STIR images and is located between the gluteus medius and maximus muscles proximally and between gluteus medius and minimus muscles distally. Probable involvement of the left pyriformis is noted. There is extension of this lesion into the pelvis, upto the presacral region through the left sacro-sciatic notch. Extension of the soft tissue lesion into the presacral space and into the spinal canal in the sacral region is also noted.
Similar signal intensity lesions, but of significantly smaller size are noted in the left paravertebral regions (lateral to the psoas muscle) and along the left ilio-psoas muscle in the pelvis.
Evidence of previous surgery is noted in the soft tissues in the left iliac region.
The uterus and its adnexae show no obvious intrinsic lesion. There is no free fluid in the pelvis. No obviously enlarged pelvic lymph nodes are identified.
1. Altered signal in the sacral segments as described, most likely represents osteitis probably tuberculous osteitis.
2. Mass lesion in the left gluteal region, extending into the pelvis as described represents an abscess.
3. Smaller lesions along the left psoas muscle and left ilio-psoas muscle represents residual abscesses.
The patient is status post-operative for drainage of an intrapelvic abscess.
As compared to the previous MRI dated 00.00.00, there is significant reduction in size of the left psoas and ilio-psoas abscess. The left gluteal and presacral abscesses are still identified. The left gluteal abscess is largely unchanged.