Demographics:
65 years old, Male
Indication:
Sepsis
Findings
Lower chest
- Mild dependent atelectasis and subpleural reticulation
- Small right greater than left pleural effusions
- Small hiatal hernia
Abdomen/Pelvis
- Prostate is enlarged with a 4 x 3 x 2 cm peripherally enhancing collection extending from the mid gland to the apex
- Bilateral perianal peripherally enhancing tracks with internal locules of gas extending toward the prostatic apex
- Urinary bladder is decompressed around a Foley catheter with circumferential mural thickening
- Punctate hepatic hypoattenuating lesion adjacent to the falciform ligament, too small to characterize
- Pancreatic divisum
- Asymmetric right renal atrophy with mild urothelial thickening and enhancement of the right renal pelvis
- Mild left hydronephrosis
- Trace ascites
- Colonic diverticulosis
- Small fat-containing left inguinal hernia
- Atherosclerotic calcification of the abdominal aorta and branch vessels without aneurysm
MSK
- No acute findings
- S-shaped scoliotic curvature of the thoracolumbar spine with severe multilevel degenerative changes, most advanced at L1-L2
- Anterior wedging of the L1 vertebral body
Diagnosis
Prostatic abscess with perianal fistulae
Sample Report
4 cm peripherally enhancing collection in the prostate concerning for prostatic abscess.
Bilateral peripherally enhancing perianal tracks extending toward the prostatic apex are concerning for perianal fistula formation.
Mural thickening of the urinary bladder and urothelial thickening of the right renal pelvis are nonspecific, but could relate to urinary tract infection. Recommend correlation with urinalysis.
Small pleural effusions.
L1 compression fracture, likely chronic. MRI could assess for superimposed acute fracture if there is clinical concern.
Discussion