Prostatitis

Extrapulmonary

tuberculosıs: an old but resurgent problem. Tuberculous prostatitis (abscesses) in a 53-year-old male. T2 weighted axial (a) and sagittal (b) MR images demonstrate focal, hypointense lesions within the prostate gland (arrows). Contrast-enhancement T1 weighted axial (c) and sagittal (b) MR images show heterogeneous lesions with peripheral enhancement (arrows). A rectal tumor (star) is also seen

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Prostatitis

• Acute bacterial prostatitis and abscess - Ganzer Fall bei Radiopaedia

Hsu C, Acute bacterial prostatitis and abscess. Case study, Radiopaedia.org (Accessed on 06 Jan 2023) https://doi.org/10.53347/rID-19079 • CC by-nc-sa 3.0 (modified)

Prostatitis

• Prostatic abscess - Ganzer Fall bei Radiopaedia

Patel M, Prostatic abscess. Case study, Radiopaedia.org (Accessed on 06 Jan 2023) https://doi.org/10.53347/rID-13513 • CC by-nc-sa 3.0 (modified)

Prostatitis

• Severe urinary tract infection with complicating prostatic abscess - Ganzer Fall bei Radiopaedia

Alabd M, Severe urinary tract infection with complicating prostatic abscess. Case study, Radiopaedia.org (Accessed on 06 Jan 2023) https://doi.org/10.53347/rID-41479 • CC by-nc-sa 3.0 (modified)

Radiopaedia • CC-by-nc-sa 3.0 • de

Prostatitis refers to an infection or inflammation of the prostate gland that presents as several syndromes with varying clinical features. Prostatitis is a clinical diagnosis and imaging is useful to evaluate abscess formation.

Pathology

The National Institutes of Health (NIH) have classified prostatitis into four distinct syndromes :

I: acute bacterial prostatitis
II: chronic bacterial prostatitis
III: chronic prostatitis and chronic pelvic pain syndrome (CPPS)
- further subclassified as inflammatory or non-inflammatory
IV: asymptomatic inflammatory prostatitis

Radiographic features

Ultrasound

Focal hypoechoic region in the peripheral zone of the gland. Discrete fluid collection suggests abscess formation. Color Doppler ultrasound demonstrates increased flow in the periphery of the abscess.

CT

Contrast-enhanced CT is the best imaging tool if abscess suspected and will demonstrate a diffusely enlarged, edematous gland with predilection for peripheral zone involvement.

When an abscess is present it is seen as a rim-enhancing, unilocular or multilocular, hypodensity in the peripheral zone. Central zone involvement is encountered in status post-transurethral resection of the prostate (TURP) patients. The infection can extend through the capsule into the periprostatic tissues, seminal vesicles, and peritoneum.

MRI

The prostate will be diffusely enlarged, often with associated inflammatory changes of periprostatic fat and of the seminal vesicles .

Acute prostatitis

T1: peripheral zone iso- or hypointense to transition zone
T2: hyperintense
T1 C+ (Gd) diffusely enhancing

Treatment and prognosis

Antibiotics are the mainstay of treatment for bacterial prostatitis. In cases of chronic non-bacterial prostatitis, diuretics and anti-inflammatory medications may be needed instead.