A's Mommy's MRI with Dr. Potter
Posted: Wed Oct 20, 2010 5:24 pm
MRI of the pelvis
MRI of the pelvis was performed utilizing coronal fast inversion recovery, followed by coronal, sagittal, axial and oblique axial fast spin echo techniques followed by postcontrast axial fat suppressed oblique axial T1-weighted sequencing. Concern is pudendal nerve entrapment, particularly on the left. The patient by history has undergone laparoscopy and hysteroscopy to remove adhesions as well as correction of the uterus from a septate to a now arcuate configuration.
Sagittal images demonstrate post-traumatic deformity of the coccyx, with angulation such that the tip extends posteriorly and somewhat asymmetric to the left. There is linear scar formation surrounding the posterior margin of the rectosigmoid junction that extends towards the branch of the pudendal nerve towards the rectum. In the pelvic floor, there is also scarring of the anterior margin of Alcock's canal, which surrounds perivaginal fat planes, left greater than right. Following contrast administration, there is only mild enhancement.
Of additional note is marked prominence of pelvic floor venous plexus, indicative of pelvic floor varices which may correlate to pelvic venous congestion syndrome. The lack of inherent fat in the lower pelvis combined with the pelvic floor varices efface the fat planes of the pudendal nerve.
Coronal images more anteriorly demonstrate intact appearance of the genitofemoral and ilioinguinal nerves. Similarly, the obturator nerves demonstrate intact perineural fat plane throughout the field of view.
There is no pelvic adenopathy. The pelvic floor muscles appear symmetric bilaterally without disproportionate atrophy. Posteriorly, the sciatic nerves are symmetric. The fat planes surrounding the presacral plexus are unremarkable.
Mild resorption of the inferior margin of the pubic symphisis is seen, reflecting the effects of childbirth. There is no dehiscence of the rectus abdominus aponeurosis.
Moderate amount of free fluid is seen in the cul-de-sac. There is a dominant left adnexal cyst that is not individually enlarged by size criteria.
Impression:
MRI of the pelvis demonstrates findings consistent with pelvic venous congestion syndrome with marked distension of the pericervical venous plexus, impinging on the pudendal nerves of the pelvic floor but with additional perineural scarring of the anterior margin of Alcock's canal, left greater than right. Further, there is post-traumatic deformity of the tip of the coccyx, with mild scar surrounding the rectal fat planes, as outlined above.
MRI of the pelvis was performed utilizing coronal fast inversion recovery, followed by coronal, sagittal, axial and oblique axial fast spin echo techniques followed by postcontrast axial fat suppressed oblique axial T1-weighted sequencing. Concern is pudendal nerve entrapment, particularly on the left. The patient by history has undergone laparoscopy and hysteroscopy to remove adhesions as well as correction of the uterus from a septate to a now arcuate configuration.
Sagittal images demonstrate post-traumatic deformity of the coccyx, with angulation such that the tip extends posteriorly and somewhat asymmetric to the left. There is linear scar formation surrounding the posterior margin of the rectosigmoid junction that extends towards the branch of the pudendal nerve towards the rectum. In the pelvic floor, there is also scarring of the anterior margin of Alcock's canal, which surrounds perivaginal fat planes, left greater than right. Following contrast administration, there is only mild enhancement.
Of additional note is marked prominence of pelvic floor venous plexus, indicative of pelvic floor varices which may correlate to pelvic venous congestion syndrome. The lack of inherent fat in the lower pelvis combined with the pelvic floor varices efface the fat planes of the pudendal nerve.
Coronal images more anteriorly demonstrate intact appearance of the genitofemoral and ilioinguinal nerves. Similarly, the obturator nerves demonstrate intact perineural fat plane throughout the field of view.
There is no pelvic adenopathy. The pelvic floor muscles appear symmetric bilaterally without disproportionate atrophy. Posteriorly, the sciatic nerves are symmetric. The fat planes surrounding the presacral plexus are unremarkable.
Mild resorption of the inferior margin of the pubic symphisis is seen, reflecting the effects of childbirth. There is no dehiscence of the rectus abdominus aponeurosis.
Moderate amount of free fluid is seen in the cul-de-sac. There is a dominant left adnexal cyst that is not individually enlarged by size criteria.
Impression:
MRI of the pelvis demonstrates findings consistent with pelvic venous congestion syndrome with marked distension of the pericervical venous plexus, impinging on the pudendal nerves of the pelvic floor but with additional perineural scarring of the anterior margin of Alcock's canal, left greater than right. Further, there is post-traumatic deformity of the tip of the coccyx, with mild scar surrounding the rectal fat planes, as outlined above.
