Presacral ultrasound shows "thickening/edema of subcutaneous fatty tissue". painful and hard lump under the skin and can be felt. surgical removal?

U/S is non specific: You need diagnosis. More history. The U/S adds a little but not enough. MRI would also add info, but again may not be enough. MRI would be most sensitive in seeing borders and might give useful info for a surgeon, for ex. vascularity. Only surgeons can decide on incisional bx. vs. excision. Hacking around is cheapest, but for me (a radiologist) MRI is good to avoid surprises and safe to do.