Answer for BIR CoW 03 Mar 2024
Prostatic abscess
Findings
Prostate appear enlarged measuring 28 cc. T1 hypointense / T2 hyperintense multiseptated fairly defined collection with internal T2 hypointensity showing marked diffusion restriction with low ADC values occupying predominantly the apex and mid body of left side of prostate.
Diagnosis
Features suggestive of Prostatic abscess with subcapsular extension.
Imaging differential diagnosis
Cystic prostatitis
Cystic prostatic carcinoma
Discussion
Prostatic abscess is a localized collection of purulent fluid within the prostate, often forming as a complication of acute bacterial prostatitis
Typically affects men aged 20 to 40 years and over 60 Symptoms are generally acute and include urinary frequency, perineal pain, and dysuria Etiology - develops as a complication of acute prostatitis, primarily from reflux of infected urine into the prostatic ducts during voiding. tends to affect diabetic and immunosuppressed patients.
Organisms usually involved include: Escherichia coli Staphylococcus and Gonococcus (rare)
Radiographic features –
Trans-rectal Ultrasound (TRUS) - ill-defined hypoechoic areas within an enlarged or distorted prostate gland
CT - the prostate gland can either be symmetrically or asymmetrically enlarged and shows well defined areas of low attenuation.
MRI – T1 hypointense and T2 hyperintense , shows diffusion restriction on DWI and peripheral enhancement on contrast.
Management - Percutaneous transperineal or transrectal drainage is often considered the first choice for therapy
References
Lee DS, Choe HS, Kim HY, Kim SW, Bae SR, Yoon BI, Lee SJ. Acute bacterial prostatitis and abscess formation. BMC Urol. 2016 Jul 07;16(1):38. [PMC free article] [PubMed] Ackerman AL, Parameshwar PS, Anger JT. Diagnosis and treatment of patients with prostatic abscess in the post-antibiotic era. Int J Urol. 2018 Feb;25(2):103-110. [PubMed]
Findings
Prostate appear enlarged measuring 28 cc. T1 hypointense / T2 hyperintense multiseptated fairly defined collection with internal T2 hypointensity showing marked diffusion restriction with low ADC values occupying predominantly the apex and mid body of left side of prostate.
Diagnosis
Features suggestive of Prostatic abscess with subcapsular extension.
Imaging differential diagnosis
Cystic prostatitis
Cystic prostatic carcinoma
Discussion
Prostatic abscess is a localized collection of purulent fluid within the prostate, often forming as a complication of acute bacterial prostatitis
Typically affects men aged 20 to 40 years and over 60 Symptoms are generally acute and include urinary frequency, perineal pain, and dysuria Etiology - develops as a complication of acute prostatitis, primarily from reflux of infected urine into the prostatic ducts during voiding. tends to affect diabetic and immunosuppressed patients.
Organisms usually involved include: Escherichia coli Staphylococcus and Gonococcus (rare)
Radiographic features –
Trans-rectal Ultrasound (TRUS) - ill-defined hypoechoic areas within an enlarged or distorted prostate gland
CT - the prostate gland can either be symmetrically or asymmetrically enlarged and shows well defined areas of low attenuation.
MRI – T1 hypointense and T2 hyperintense , shows diffusion restriction on DWI and peripheral enhancement on contrast.
Management - Percutaneous transperineal or transrectal drainage is often considered the first choice for therapy
References
Lee DS, Choe HS, Kim HY, Kim SW, Bae SR, Yoon BI, Lee SJ. Acute bacterial prostatitis and abscess formation. BMC Urol. 2016 Jul 07;16(1):38. [PMC free article] [PubMed] Ackerman AL, Parameshwar PS, Anger JT. Diagnosis and treatment of patients with prostatic abscess in the post-antibiotic era. Int J Urol. 2018 Feb;25(2):103-110. [PubMed]
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!