A pilonidal region sinogram is a targeted radiographic imaging procedure designed to assess sinuses or fistulous tracts in the pilonidal area, typically located near the sacrococcygeal region at the top of the gluteal cleft, by injecting a radiopaque contrast agent, such as an iodinated solution, into the external opening of the tract. Performed under fluoroscopy, this technique allows real-time visualization as the contrast flows through the sinus, mapping its extent, depth, and any branching or connections to surrounding tissues, which appear as outlined pathways on the resulting X-ray images. It is primarily used to evaluate pilonidal sinuses—chronic conditions often arising from hair follicle irritation or infection—helping clinicians determine the complexity of the tract and plan surgical excision or drainage by distinguishing simple sinuses from more extensive networks. The procedure involves minimal invasion, with the patient usually positioned prone, and while it effectively highlights the tract’s anatomy against the softer tissue background, it may cause slight discomfort during contrast administration. Although highly specific for delineating the sinus path, its scope is limited to the contrast-filled area, occasionally necessitating MRI or CT for a more comprehensive view of deeper or inflammatory changes.

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