A perianal region sinogram is a specialized radiographic imaging procedure used to evaluate fistulas, sinuses, or abnormal tracts in the soft tissues surrounding the anus and lower rectum, typically performed by injecting a water-soluble contrast agent, such as iodinated dye, into the external opening of the suspected tract. Under fluoroscopic guidance, real-time X-ray imaging tracks the contrast as it fills the pathway, outlining its course, depth, and any connections to the anal canal, rectum, or adjacent structures, producing a detailed two-dimensional map of the abnormality. This technique is particularly useful for diagnosing perianal fistulas—often associated with conditions like Crohn’s disease or chronic abscesses—by revealing their complexity, branching patterns, and relationship to the anal sphincter muscles, which is critical for surgical planning. The procedure is minimally invasive, performed with the patient in a prone or lateral position, and provides high-contrast images of the tract against the softer tissue background, though it may cause mild discomfort during contrast injection. While effective for superficial and deep tract visualization, it is limited to the path filled by contrast and may be supplemented with MRI for a broader soft tissue assessment if needed.

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