Diagnostic ultrasound ( PDFDrive )

390 PART II Abdominal and Pelvic Sonography
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FIG. 10.8 Prostatitis. Most men with prostatitis have a normal-appearing
prostate that can be exceedingly tender if the condition is acute. (A) Biopsyproven
nonacute inlammation. Multiple geographic hypoechoic areas on both
sides (arrows) mimic tumor on transrectal ultrasound (TRUS) and Doppler and
are associated with prostate-speciic antigen (PSA) elevation. (B) Power Doppler
ultrasound demonstrates increased vascularity in areas of inlammation (*).
(C) BCG noncaseating granulomatous prostatitis as a mass lesion (arrow)
in a man whose bladder cancer had been treated with bacille Calmette-Guérin
(BCG) instillation. This mimics tumor, but the diagnosis can be suspected from
the history. (D) Granulomatous prostatitis mimics cancer and here appears
as a tumor extending beyond the capsule and invading the rectal wall (arrow);
I, inlammatory mass. (E) Large prostate abscess in acquired immunodeiciency
syndrome (AIDS) patient. Virtually the entire prostate is replaced by the abscess
collection (*). This patient and other patients with abscess have responded
rapidly to one or two TRUS-guided abscess aspirations and antibiotics. N, Node.
Other infectious or inlammatory conditions afecting the
prostate do not it easily into these groups. hese include
conditions such as malacoplakia, eosinophilic prostatitis, cytomegalovirus
(CMV) prostatitis, and granulomatous prostatitis.
Granulomatous prostatitis is usually idiopathic but can follow
prior instrumentation and may be caused by bacteria (e.g.,
tuberculosis, brucellosis, syphilis), fungi (e.g., coccidioidomycosis,
blastomycosis, histoplasmosis, cryptococcosis), and parasites
(e.g., schistosomiasis). Most cases in North America are caused
by bacille Calmette-Guérin (BCG). BCG is commonly instilled
into the bladder to treat transitional cell carcinoma. It leaks into
the prostate, where it can cause granulomatous inlammation.
Granulomatous prostatitis mimics cancer on DRE, TRUS, and
mpMRI and elevates PSA level. A history of BCG instillation
can be reassuring, but biopsy generally is needed to exclude
cancer. 1,38
Prostate Cysts
Prostate cysts are common and have been grouped into six
categories: (1) parenchymal cysts, (2) isolated medial cysts (utricle