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16b - Answer: 71-year-old male presents with elevated PSA level

Pomeranz, Stephen
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
Includes DICOM files

HISTORY: 

This 71-year-old male presents with elevated PSA level measuring 10.9ng/mL. History of negative biopsy.

PRIMARY FINDING: 

PI-RADS II.

FINDINGS:

The prostate gland measures 7cm in CC, 4.3cm in AP and 5.2cm in RL dimensions. Calculated prostate volume is 81cc and PSA density is 0.13. Transitional zone hyperplasia is present and demonstrates substantive indentation to the urinary bladder outflow tract. No suspicious T2 hypointensity with high grade diffusion restriction to suggest malignant neoplastic process in the transitional zone. Linear scarring areas are seen in the peripheral zone. Midline cyst measuring 0.3cm in diameter in the posterior peripheral zone consistent with Mullerian duct or utricle cyst. Anatomical prostate capsule, bilateral neurovascular bundles and seminal vesicles are unremarkable. 

No lymphadenopathy in the pelvis or inguinal regions. 

Urinary bladder is not full. No intraluminal filling defect identified. 

Rectal wall and rectal prostate angles are clear. 

No abnormal osseous enhancement identified. 

Small fat containing left inguinal hernia is present. 

CONCLUSION

1. PI-RADS 2/5, benign hyperplasia of the transitional zone. 

2. Substantive indentation to the urinary bladder floor outflow tract by enlarged transitional zone. 

3. Small fat containing left inguinal hernia.

LESSON 2, TOPIC 48

Case Challenge: Prostate MRI Cases

Case Challenge

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Content reviewed: October 25, 2021

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