Presentation
Multiple discharging sinuses in bilateral gluteal regions
Patient Data
Osteolytic destruction of lower sacrum with erosions in inferior aspect of S2 and associated marrow edema in S1, S2.
Osteolytic bone fragments are seen within and around sacral spinal canal.
Large soft tissue lesion containing multiple hypointensities within, measuring approx. 88 x 80 x 74 mm (AP X TD X CC) is seen involving sacral canal and causing its widening. It shows evidence of diffusion restriction. It is extending to prescaral space and right sciatic notch. Right sciatic nerve appears thickened and edematous.
The lesion is abutting right seminal vesicle. No obvious communication is seen with rectum, anal canal and visualized bowel loops.
Multiple sinus tracts are seen arising from the above mentioned soft tissue lesion, extending to bilateral gluteal regions.
Small collection is seen within left piriformis muscle, at left lateral aspects of above mentioned lesion.
Gross inflammatory fat stranding is seen involving bilateral piriformis, gluteus maximus and lower posterior paraspinal muscles with possible other small sinuses / collections.
Multiple areas of fibrosis and scar formation are seen in bilateral gluteal regions.
Rest of pelvic bones are unremarkable
Case Discussion
Overall above findings are suggestive of large mycetoma involving sacrum, sacral canal, prescaral region and bilateral gluteal regions with multiple sinus tracts and surrounding inflammatory stranding as described.
This case demonstrates the “dot-in-circle” sign of mycetoma, seen as tiny hypointense foci within the hyperintense spherical lesions.
Pathological correlation is not available as the patient was lost to follow-up.
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