Presentation
Suprapubic pain with dysuria and fever.
Patient Data
Enlarged prostate (volume around 140 cc) with an ill-defined cystic cavity of a thick irregular wall and inhomogeneous fluid content (mimicking a distended fluid-filled rectum).
Increase prostatic volume with a large irregular partially septated intraprostatic fluid collection measuring 74 x 58 x 55 mm, located mainly in the right transition and peripheral zones. It displays a low signal on T1, high signal on T2 with restricted diffusion (very low ADC) and peripheral enhancement on postcontrast sequences. Another small collection (15 mm) is also noted in the left peripheral zone. Right anterolateral extraprostatic spread is noted with involvement of the obturator internus muscle.
No apparent extension to the posterior vesical wall, anterior rectal wall or the seminal vesicles.
Small reactive internal iliac lymphadenopathy.
Right inguinal hernia is noted.
Case Discussion
The ultrasound and MRI features are most consistent with prostatic abscess with extra-prostatic spread. Ultrasound-guided transrectal drainage was advised.
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