46b - Answer: 46-year-old male presents with hematospermia for the past 6-7 months
HISTORY:
This 46-year-old male presents with hematospermia for the past 6-7 months. PSA level 0.9.
PRIMARY FINDING:
PI-RADS 1 of 5.
FINDINGS:
Prostate gland is upper limits of normal volume measuring 4.48 x 3.27 x 3.62cm for a volume of 34.71ml (bullet calculation). No suspicious nodule demonstrated, restricted diffusion or early arterial phase enhancement within the prostate gland. No T1 hyperintensities in the prostate gland, seminal vesicles, or ejaculatory ducts to suggest methemoglobin staining from acute hemorrhage or from active hemorrhage. Volume loss symmetrically involves both seminal vesicles with desiccation. No sizable stone in the posterior urethra. No cystic rim-enhancing change within prostate gland to suggest abscess. Smooth muscle hypertrophy involves both vas deferens with asymmetric fluid within the lumen of each, right greater than left. Collapse with paucity of fluid seen in left seminal vesicle with small amount of fluid seen in right seminal vesicle. No pathologic enhancement about the seminal vesicles to suggest vesiculitis. No pathologic enhancement about either vas deferens to suggest vasitis.
Rectal mucosa normal pattern and thickness. Urinary bladder has smooth wall with normal thickness. No suspicious intravesicular filling defect. No evidence of distal hydroureter. No enlarged inguinal or intrapelvic lymph node.
No acute osseous abnormality. No suspicious osseous lesion in the visualized axial or proximal appendicular skeleton. Red marrow reconversion seen in the ischium and pubic bones; findings that can be correlated for any anemia or chronic smoking history. Mild tendinopathy involves both hamstring tendon origins without tear.
CONCLUSION:
1. PI-RADS 1 of 5, benign appearance of prostate gland. No suspicious nodule, invasion of the anatomic capsule, invasion of the surgical capsule, invasion of the rectoprostatic angles, invasion into the urinary bladder, invasion into rectum, or invasion into seminal vesicles.
2. Collapse/desiccation of seminal vesicles, more pronounced on the left. Smooth muscle hypertrophy in both vas deferens (may be postinflammatory). No pathologic enhancement of either vas deferens or either seminal vesicles to suggest infectious vasitis or vesiculitis. No fluid collection or suspicious enhancement to suggest prostatitis or prostatic abscess.
3. Normal MRI evaluation of urinary bladder. No pathologic enhancement along course of urethra to suggest infectious urethritis.
Case Challenge: Prostate MRI Cases
Case Challenge
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Content reviewed: October 25, 2021