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PILONIDAL SINUS<br />IMAGING  CHALLANGE                                       DIFFERENTIATE                               ...
RADIOLOGICAL RESPONSIBITY<br />  Mathematical Assesment<br />DEFINE THE SEPSIS <br />TRACT / SECONDARY TRACT , RAMIFICATIO...
MRI CAN SUPPORT DIFFERENTIATION  <br />PILONIDAL SINUS<br />FISTULA IN ANO<br />NATAL CLEFT SEPSIS <br />EXTENSION TO COCC...
PRESENT CASE <br />CLINICAL BRIEF <br /> MOST IMPORTANT  IMAGING PLANE <br />26 YR FEMALE  WITH <br />? PILONIDAL SINUS <b...
NATAL CLEFT  SEPSIS WITH LOCULI AND TRACT REACHING THE  MEDIAL SIDE OF THE LEFT LABIA<br />
PERINATAL SEPSIS WITH LOCULI AND TRACT REACHING THE  MEDIAL SIDE OF THE LEFT LABIA.<br />DIFFUSE NATURE OF THE SEPSIS APPR...
TRACT ABUTING THE EXTERNAL ANAL SPHINCTER<br />THE INTERSPHINCTERIC PLANE IS NORMAL.<br />EXTERNAL ANAL OPENING <br />
LONGITUDINAL EXTENT OF THE TRACT ABUTING THE EXTERNAL ANAL SPHINCTER <br />LOCULI IN THE TRACT<br />RAMIFICATIONS IN THE T...
EDUCATION :  Natal cleft sepsis with external opening posterior to the anal canal  and extension  of the sepsis  to the  c...
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Pilonidal sinus

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Transcript of "Pilonidal sinus"

  1. 1. PILONIDAL SINUS<br />IMAGING CHALLANGE DIFFERENTIATE Pilonidal sinus from fistula in ano. <br />MERCURY IMAGING INSTITUTE <br />SCO 172-173 SEC 9C CHANDIGARH<br />MERCURY IMAGING CENTRE <br />SCO 16-17 SEC 20D CHANDIGARH<br />
  2. 2. RADIOLOGICAL RESPONSIBITY<br /> Mathematical Assesment<br />DEFINE THE SEPSIS <br />TRACT / SECONDARY TRACT , RAMIFICATIONS. <br />LOCULI<br />EXTENT ( SACRUM / COCCYX )<br />SITE ( NATAL CLEFT , PERIANAL , ISHIOANAL , ISCHIO RECTAL , SUPRALEVATOR , INTERSPINCTERIC )<br />EXTERNAL OPENING <br />USE THE ANAL CLOCK<br /> PILONIDAL SINUS <br /> ( POSTERIOR TO THE ANAL OPENING).<br />INTERNAL OPENING <br /> ENTERIC –SUPPORTS FISTULA IN ANO. <br /> Definition to help.<br />Natal cleft : The area of buttock 2 cm posterior to the anal opening<br />Perianal : The area with in 2cm of the anal opening<br />
  3. 3. MRI CAN SUPPORT DIFFERENTIATION <br />PILONIDAL SINUS<br />FISTULA IN ANO<br />NATAL CLEFT SEPSIS <br />EXTENSION TO COCCYX<br />EXTENSION TO SACRUM<br />NO INTERSPHINCTERIC SEPSIS<br />NO ENTERIC COMMUNICATION<br />MAY HAVE ISCHIOANAL,PERIANAL,SUPRA-LEVATOR SEPSIS <br />FOLLICULITIS AS ETIOLOGY<br />INTERSPHINCTERIC SEPSIS<br />ENTERIC COMMUNICATION<br /> MAY HAVE PERIANAL/ISCHIOANAL/ SUPRALEVATOR SEPSIS. <br />INFECTION IN THE CRYPTOGLANDULAR GLANDS AT DENTATE LINE AND EXTENSION OUTWARDS IS CONSIDERED AS ETIOLOGY.<br />
  4. 4. PRESENT CASE <br />CLINICAL BRIEF <br /> MOST IMPORTANT IMAGING PLANE <br />26 YR FEMALE WITH <br />? PILONIDAL SINUS <br />? FISTULA IN ANO.<br />ON DIGITAL RECTAL EXAMINATION NO INTERNAL ENTERIC OPENING APPRECIATED IN THE STUDY.<br />SAGITTAL SECTION<br />LONG AXIS OF THE ANAL CANAL<br />
  5. 5. NATAL CLEFT SEPSIS WITH LOCULI AND TRACT REACHING THE MEDIAL SIDE OF THE LEFT LABIA<br />
  6. 6. PERINATAL SEPSIS WITH LOCULI AND TRACT REACHING THE MEDIAL SIDE OF THE LEFT LABIA.<br />DIFFUSE NATURE OF THE SEPSIS APPRECIATED <br />
  7. 7. TRACT ABUTING THE EXTERNAL ANAL SPHINCTER<br />THE INTERSPHINCTERIC PLANE IS NORMAL.<br />EXTERNAL ANAL OPENING <br />
  8. 8. LONGITUDINAL EXTENT OF THE TRACT ABUTING THE EXTERNAL ANAL SPHINCTER <br />LOCULI IN THE TRACT<br />RAMIFICATIONS IN THE TRACT<br />ISCHIO ANAL FAT<br />EXTERNAL ANAL SPHINCTER<br />
  9. 9. 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. <br />
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