Prostataabszess

Prostatic
abscess: multidetector CT findings and role. Preliminary unenhanced acquisition showed prostatic enlargement (arrowheads), mostly occupied by hypoattenuating (17-19 Hounsfield Units) areas. Note Foley catheter (short arrow) in place.
www.eurorad.org • CC by-nc-sa-4.0
Prostatic
abscess: multidetector CT findings and role. Contrast-enhanced images confirmed marked, asymmetric (approx.10x8x9 cm) prostatic enlargement (arrowheads) occupied by confluent nonenhancing hypoattenuating regions, with peripheral and septal enhancement. Note catheter (short arrow).
www.eurorad.org • CC by-nc-sa-4.0
Prostatic
abscess: multidetector CT findings and role. Contrast-enhanced images confirmed marked, asymmetric (approx.10x8x9 cm) prostatic enlargement (arrowheads) occupied by confluent nonenhancing hypoattenuating regions, with peripheral and septal enhancement. Note catheter (short arrow).
www.eurorad.org • CC by-nc-sa-4.0
Prostatic
abscess: multidetector CT findings and role. Multiplanar reconstructions depicted the marked, asymmetric prostatic enlargement (arrowheads) with confluent nonenhancing hypoattenuating regions, with peripheral and septal enhancement.
www.eurorad.org • CC by-nc-sa-4.0
Prostatic
abscess: multidetector CT findings and role. Multiplanar reconstructions depicted the marked, asymmetric prostatic enlargement (arrowheads) with confluent nonenhancing hypoattenuating regions, with peripheral and septal enhancement. Note displaced urinary bladder with mucosal hyperenhancement (thin arrow).
www.eurorad.org • CC by-nc-sa-4.0
Differential
diagnosis of uncommon prostate diseases: combining mpMRI and clinical information. Prostate abscess in a 68-year-old male with dysuria for 2 months and a serum PSA level of 9.50 ng/mL, 16.9 white blood cells/high power field in urine and 1.7 epithelial cells /high power field in urine. a, b T2- and T1-weighted imaging show a mass with high T2 signal intensity and low T1 signal intensity (☆) in the PZ compressing the rectum. c, d The interior of the mass shows a very high signal intensity on DWI at a b-value of 800 s/mm2 and a very low signal intensity on the ADC maps (☆). e DCE imaging shows enhancement of the rim and separations in the middle (arrow)
insightsimaging.springeropen.com • CC-by-4.0
Incidental
findings in and around the prostate on prostate MRI: a pictorial review. Prostate abscess a, b Axial T2W images show left lateral bladder wall thickening (red arrow) and heterogeneous but predominantly low T2 signal in the left prostate (white arrow), respectively. c Post-contrast, the lesion demonstrates strong peripheral contrast enhancement and on DWI/ ADC in d, e, respectively, the central element of the left prostate lesion shows restricted diffusion with a very low ADC value
insightsimaging.springeropen.com • CC-by-4.0
Radiopaedia • CC-by-nc-sa 3.0 • de

Prostatic abscesses are a rare complication of prostatitis.

Epidemiology

Prostatic abscesses have become relatively uncommon due to the increased use of antibiotic therapy in patients with prostatitis. It tends to affect diabetic and immunosuppressed patients. Most patients affected are around 50 to 60 years old .

Clinical presentation 

Patients commonly present with dysuria, fever, suprapubic pain, and possibly urinary retention. Urinalysis reveals leukocytes. Clinically the condition may appear similar to acute bacterial prostatitis without abscess formation .

Pathology

The organisms usually involved include:

  • Escherichia coli
  • Staphylococcus spp.
  • Gonococcus spp. (rare)

Radiographic features

Ultrasound

Transrectal sonography (TRUS) is considered a very reliable imaging method to diagnose a prostatic abscess . It usually demonstrates ill-defined hypoechoic areas within an enlarged and/or distorted prostate gland. There may be inhomogenous echoes within these ill-defined areas .

CT
  • tends to show well defined areas of low attenuation
  • the prostate gland can either be symmetrically or asymmetrically enlarged
MRI

MRI signal characteristics of an abscess include

  • T1: hypointense
  • T2: hyperintense
  • T1 C+ (Gd): tends to show peripheral contrast enhancement.
  • DWI
    • limited studies only
    • tends to show restriction of diffusion corresponding to hypoechoic lesions on ultrasound
  • ADC
    • limited studies only
    • mean ADC values within the abscesses have been reported to be very low

Treatment and prognosis

Percutaneous transperineal or transrectal drainage is often considered the first choice for therapy due to the lower risk of complication compared with surgery. A TRUS guided aspiration is also reported to be an effective and minimally invasive treatment modality.

Complications

Differential diagnosis

Imaging differential considerations include:

See also

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Prostataabszess:
Adenokarzinom
der Prostata
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