PMC3956695_01
Pilonidal abscess, sagittal computed tomography (CT) images on admission (A) and time of neutrophil recovery (B). (A) CT scan showing soft-tissue ill-defined thickening from the lumbar spine to the sacrum, with a focal well-defined fluid collection measuring approximately 2.9 x 0.8 cm (arrow). (B) Three weeks postinduction CT sagittal images showing increase in well-defined fluid collection, now measuring 1.3 x 2.2 x 6.4 cm (marked with arrow).
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There was also a well-defined fluid collection measuring approximately 2.9 x 0.8 cm within the subcutaneous tissues, superficial to the lower sacrum and to the right of the midline (Figure 1A). CT of the pelvis showed an increase in size of well-defined fluid collection, measuring 1.3 x 2.2 x 6.4 cm (Figure 1B).
PMC3956695_02
(A) Magnetic resonance imaging (MRI) T2 coronal images with marked edema and enhancement of the left adductor magnus and brevis muscles, with focal areas of nonenhancement consistent with myonecrosis (arrow). (B) MRI T1 fast-spin coronal images with progression of the edema and development of a fluid collection in the proximal medial thigh measuring 3.9 x 10.3 x 8.5 cm (marked with arrow).
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ANC was 80/muL, and while on piperacillin/tazobactam, the patient developed fever. A repeat MRI showed progressively evolving areas of myonecrosis/abscess in the left thigh, predominately in the abductor brevis and magnus, and unchanged to slightly decreased area of myonecrosis/abscess in the proximal right thigh, with slightly increased enhancement and edema in the adductor magnus (Figure 2A). A repeat MRI showed marked progression and enlargement of multiple fluid collections in the left thigh consistent with worsening areas of myonecrosis/abscess (Figure 2B).