Pilonidal sinus
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Pilonidal sinus

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Pilonidal sinus Pilonidal sinus Presentation Transcript

  • PILONIDAL SINUS
    IMAGING CHALLANGE DIFFERENTIATE Pilonidal sinus from fistula in ano.
    MERCURY IMAGING INSTITUTE
    SCO 172-173 SEC 9C CHANDIGARH
    MERCURY IMAGING CENTRE
    SCO 16-17 SEC 20D CHANDIGARH
  • RADIOLOGICAL RESPONSIBITY
    Mathematical Assesment
    DEFINE THE SEPSIS
    TRACT / SECONDARY TRACT , RAMIFICATIONS.
    LOCULI
    EXTENT ( SACRUM / COCCYX )
    SITE ( NATAL CLEFT , PERIANAL , ISHIOANAL , ISCHIO RECTAL , SUPRALEVATOR , INTERSPINCTERIC )
    EXTERNAL OPENING
    USE THE ANAL CLOCK
    PILONIDAL SINUS
    ( POSTERIOR TO THE ANAL OPENING).
    INTERNAL OPENING
    ENTERIC –SUPPORTS FISTULA IN ANO.
    Definition to help.
    Natal cleft : The area of buttock 2 cm posterior to the anal opening
    Perianal : The area with in 2cm of the anal opening
  • MRI CAN SUPPORT DIFFERENTIATION
    PILONIDAL SINUS
    FISTULA IN ANO
    NATAL CLEFT SEPSIS
    EXTENSION TO COCCYX
    EXTENSION TO SACRUM
    NO INTERSPHINCTERIC SEPSIS
    NO ENTERIC COMMUNICATION
    MAY HAVE ISCHIOANAL,PERIANAL,SUPRA-LEVATOR SEPSIS
    FOLLICULITIS AS ETIOLOGY
    INTERSPHINCTERIC SEPSIS
    ENTERIC COMMUNICATION
    MAY HAVE PERIANAL/ISCHIOANAL/ SUPRALEVATOR SEPSIS.
    INFECTION IN THE CRYPTOGLANDULAR GLANDS AT DENTATE LINE AND EXTENSION OUTWARDS IS CONSIDERED AS ETIOLOGY.
  • PRESENT CASE
    CLINICAL BRIEF
    MOST IMPORTANT IMAGING PLANE
    26 YR FEMALE WITH
    ? PILONIDAL SINUS
    ? FISTULA IN ANO.
    ON DIGITAL RECTAL EXAMINATION NO INTERNAL ENTERIC OPENING APPRECIATED IN THE STUDY.
    SAGITTAL SECTION
    LONG AXIS OF THE ANAL CANAL
  • NATAL CLEFT SEPSIS WITH LOCULI AND TRACT REACHING THE MEDIAL SIDE OF THE LEFT LABIA
  • PERINATAL SEPSIS WITH LOCULI AND TRACT REACHING THE MEDIAL SIDE OF THE LEFT LABIA.
    DIFFUSE NATURE OF THE SEPSIS APPRECIATED
  • TRACT ABUTING THE EXTERNAL ANAL SPHINCTER
    THE INTERSPHINCTERIC PLANE IS NORMAL.
    EXTERNAL ANAL OPENING
  • LONGITUDINAL EXTENT OF THE TRACT ABUTING THE EXTERNAL ANAL SPHINCTER
    LOCULI IN THE TRACT
    RAMIFICATIONS IN THE TRACT
    ISCHIO ANAL FAT
    EXTERNAL ANAL SPHINCTER
  • EDUCATION : Natal cleft sepsis with external opening posterior to the anal canal and extension of the sepsis to the coccygeal / sacral region with no interspincertic sepsis and no enteric communication suggest PILONIDAL SINUS as possibility .The fistula in ano near always has intersphincteric sepsis . Primary tract with ramifications / Enetic communication support fistula in ano . Ishioanal , ishiorectal ,translevator , suprasphicteric sepsis can be seen in both the conditions but intersphicteric sepsis is seen only in fistula in ano.