Answer for BIR CoW 13 Dec 2020
PILONIDAL SINUS DISEASE - COMPLICATED PILONIDAL SINUSES
Findings
Linear STIR hyperintense tract with adjoining soft tissue edema noted in posterior subcutaneous plane in sacro coccygeal region , abutting the midline natal cleft with multiple skin pits Small subcutaneous collection also noted On contrast administration, linear enhancement of tract noted. The internal and external anal sphincters were normal . No perianal soft tissue changes were there . The features were consistent with Pilonidal sinus Disease with small abscesses reflecting complicated pilonidal sinuses.
Discussion
Pilonidal sinus disease is common among young adults. Pathogenesis is due to infection of hair follicles at natal cleft. The sinus manifests as an infected pit in the subcutaneous tissues overlying the coccyx. There is no communication with the anal sphincter complex. There is no sepsis in the intersphincteric plane Clinical presentation ranges from asymptomatic pits to abscess with active discharge. The fistulous tract can be single or multiple and is graded as follows: Grade I-Single midline pit Grade II- Multiple midline pits without lateral extension Grade III -Midline pits with lateral extension on one side Grade IV -Midline pits with lateral extension on both sides The findings can be listed as follows: Acute pilonidal abscess: This is characterized by a tender fluctuant subcutaneous mass and surrounding cellulitis located off the midline of the natal cleft in the sacrococcygeal region. Primary openings are frequently seen on the midline natal cleft. Chronic pilonidal sinus: In these cases there is a primary opening on the midline of the natal cleft sometimes with extruding hair located 4 to 5 cm cephalad to the anus. There may be a secondary opening located off the midline. The secondary opening is usually cephalad to the primary opening and at a variable distance from it. Complicated pilonidal sinuses: Findings may include multiple skin pits on the midline of the natal cleft that lead to multiple sinuses and a secondary opening at variable distances from the midline. Partially drained abscesses may also be present. Recurrent pilonidal disease: Findings in this situation are variable and include the previous surgical scar with different degrees of surrounding fibrosis. The primary opening may or may not be visible and one or multiple secondary openings may be present Differential diagnosis: Fistula in ano and Hidradenitis suppurativa. Intersphincteric infection and an enteric opening, both of which seen in Perianal Fistula are always absent in pilonidal sinus.
Findings
Linear STIR hyperintense tract with adjoining soft tissue edema noted in posterior subcutaneous plane in sacro coccygeal region , abutting the midline natal cleft with multiple skin pits Small subcutaneous collection also noted On contrast administration, linear enhancement of tract noted. The internal and external anal sphincters were normal . No perianal soft tissue changes were there . The features were consistent with Pilonidal sinus Disease with small abscesses reflecting complicated pilonidal sinuses.
Discussion
Pilonidal sinus disease is common among young adults. Pathogenesis is due to infection of hair follicles at natal cleft. The sinus manifests as an infected pit in the subcutaneous tissues overlying the coccyx. There is no communication with the anal sphincter complex. There is no sepsis in the intersphincteric plane Clinical presentation ranges from asymptomatic pits to abscess with active discharge. The fistulous tract can be single or multiple and is graded as follows: Grade I-Single midline pit Grade II- Multiple midline pits without lateral extension Grade III -Midline pits with lateral extension on one side Grade IV -Midline pits with lateral extension on both sides The findings can be listed as follows: Acute pilonidal abscess: This is characterized by a tender fluctuant subcutaneous mass and surrounding cellulitis located off the midline of the natal cleft in the sacrococcygeal region. Primary openings are frequently seen on the midline natal cleft. Chronic pilonidal sinus: In these cases there is a primary opening on the midline of the natal cleft sometimes with extruding hair located 4 to 5 cm cephalad to the anus. There may be a secondary opening located off the midline. The secondary opening is usually cephalad to the primary opening and at a variable distance from it. Complicated pilonidal sinuses: Findings may include multiple skin pits on the midline of the natal cleft that lead to multiple sinuses and a secondary opening at variable distances from the midline. Partially drained abscesses may also be present. Recurrent pilonidal disease: Findings in this situation are variable and include the previous surgical scar with different degrees of surrounding fibrosis. The primary opening may or may not be visible and one or multiple secondary openings may be present Differential diagnosis: Fistula in ano and Hidradenitis suppurativa. Intersphincteric infection and an enteric opening, both of which seen in Perianal Fistula are always absent in pilonidal sinus.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!