Presentation
Patient was referred for abdominal and pelvic CT due to fever and diffuse abdominal pain. He had undergone radical prostatectomy 1.5 year before.
Patient Data
Status post radical prostatectomy. Diffusely thickened and trabeculated urinary bladder wall, consistent with previous obstructive uropathy.
There is a huge, encysted air-fluid collection in the right paravesical space extending to anterior pararenal region that abuts the right psoas muscle and pushes the right kidney and right hemicolon cranially and anteriorly, respectively. A collection inside the right psoas is also noted.
Similar findings are evident in the same region contralaterally, albeit the fluid collection is much smaller, with imperceptible wall and no visible air content.
Small bilateral pleural effusions are seen.
Other organs of the abdomen and pelvis are unremarkable.
Case Discussion
Findings are consistent with an infected lymphocele of the right paravesical and anterior pararenal space, causing mass-effect on the psoas muscle, kidney and right hemicolon. There is a simple lymphocele of the same region contralaterally.
Lymphoceles after prostatectomy occur as a complication of pelvic surgery, as a result of postoperative leakage from lymphatic channels. Lymphocele can present with lower urinary tract symptoms, lower abdominal pain and deep vein thrombosis. Therapeutic options for pelvic lymphocele often depend on factors such as the clinical status of the patient, size, position, infection risk, loculations and the recurrence of the collections. Symptomatic pelvic lymphoceles can be managed initially by percutaneous drainage or aspiration, with or without instillation of sclerosing agents.
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