PMC5831911_01
MRI axial imaging of the pelvis and thighs using the SPIR (Spectral Presaturation with Inversion Recovery) hybrid fat suppression technique. (a) Increased bone marrow signal with enhancement involving the symphysis pubis (arrow) consistent with osteomyelitis and moderate surrounding soft tissue edema. (b) A multiloculated fluid collection (arrow), with rim enhancement, within the right adductor muscle, measuring 3.8*2.0*7.7 cm.
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Because of his severe suprapubic pain, a MRI of the pelvis with gadolinium was requested, revealing the presence of increased bone marrow signal with enhancement involving the symphysis pubis, consisting with osteomyelitis (Figure 1(a)). A 2.1 * 1.0 cm fluid collection, with enhancing rim, was also identified, anterior to the pubis symphysis, in keeping with an abscess, and multiple other fluid collections within the adductor muscles bilaterally, largest on the right side, measuring 3.8 * 2.0 * 7.7 cm (Figure 1(b)).
MRI axial imaging of the abdomen and pelvis pre- and postadministration of intravenous Dotarem  contrast. (a) Further distention of the symphysis pubis joint secondary to an increase in size of an abscess within it (arrow), measuring 3.8*1.8 cm, compared to previous measurement of 2.0*1.5 cm. (b) Apparent pocket of air around the prostatic urethra (arrow) likely representing susceptibility artifact from surgical sutures rather than actual gas bubbles.
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Two weeks later, a follow-up MRI scan revealed a worsening of the patient's symphysis pubis septic arthritis, with increase in size of the parasymphysial abscess and surrounding inflammation (Figure 2(a)). A new finding on MRI showed, this time, the presence of gas pockets surrounding the prostatic urethra, which likely represents a susceptibility artifact from surgical sutures rather than gas bubbles (Figure 2(b)).
CT sagittal view of the abdomen and pelvis after administration of rectal enema, following the retrograde urethrogram. No evidence of contrast leakage from the bladder, urethra, or rectum is seen. No air bubbles are seen in the retropubic area in the location of the suture material that was reported on the previous MRI, confirming that the appearance on the MRI was related to surgical sutures, rather than leak. The bony abnormality in the symphysis pubis is also demonstrated in the view (arrow).
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No evidence of contrast leakage from the bladder, urethra, or rectum was noted (Figure 3).