Presentation
Severe lower abdominal pain. Diabetes and ischemic heart disease. On examination, tenderness and guarding right iliac fossa and right groin. Raised white cell count.
Patient Data
There is a peripherally enhancing fluid collection measuring 45 mm in maximal diameter involving the right seminal vesicle. The right vas deferens is hyperenhancing and the right spermatic cord is thickened with fat stranding within the right inguinal canal. Some calcification of the vas deferens and spermatic cord is noted.
Case Discussion
The CT findings led to a diagnosis of a seminal vesicle abscess with inflammation and infection extending to involve the vas deferens and spermatic cord, consistent with vasitis. Urine cultures identified E. Coli. An initial attempt at trans-rectal aspiration of the abscess was unsuccessful. He improved on intravenous antibiotics and after 4 days was discharged with a 6 week course of oral ciprofloxacin.
Case published with assistance from Dr Vikas Shah.
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