FIGURE 6 - available via license: Creative Commons Attribution 4.0 International
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Coronal T1W image. A perianal fistula (long black arrows) extending vertically from the anus (short white arrow) to the natal cleft. The vertical course of the sciatic nerve (long white arrows) is closely related to inflammatory changes in the adjacent fat (short black arrows) which may account for the presentation mimicking sciatica.
Source publication
Two unusual cases of inflammation of the external rotator muscles of the hip are presented. In each case, the patient presented with acute hip pain. The diagnoses of acute calcific periarthritis involving the gluteus medius muscle, and pyomyositis of the obturator internus muscle secondary to a perianal fistula, were made with the aid of diagnostic...
Context in source publication
Context 1
... 57-year-old man presented with pain in the left leg. Clinical examination suggested a lumbar disc lesion, but the MRI of the lumbar spine was normal. An MRI of the left hip was requested. The initial large field of view coronal images with fat suppression revealed marked oedema of the obturator internus and gemelli muscles on the left (Figure 4) with a loculated fluid component ( Figure 5) corresponding to the site and 'boomerang' shape of the obturator internus bursa. 1 Review of the pelvic viscera revealed an anorectal fistula on the left (Figure 6), containing fluid and extending to both the skin of the natal cleft and the left scrotum. The ESR was subsequently reported raised (80 mm/hr). Antibiotic therapy was initiated, to which the patient responded. A dedicated MRI fistula study was performed that did not demonstrate a direct connection to the obturator internus muscle but did show abnormal signal related to the levator ani and the pre- coccygeal soft-tissue. The patient was referred to a general surgeon for further ...
