Presentation
A few days duration of groin and lower abdominal/pelvic pain associated with dysuria and hematospermia.
Patient Data
Enlarged prostate, measuring around 40 cm³ in volume. Both seminal vesicles are diffusely enlarged, associated with stranding of the surrounding fat, signifying an underlying inflammatory process. The right ductus deferens and right spermatic cord appear enlarged. Mild reactive thickening of the urinary bladder base is present.
These findings are in keeping with changes of prostatitis, bilateral seminal vesiculitis and right vasitis.
Incidental bilateral incomplete ureteric duplication.
Tiny incidental hypoattenuating right adrenal lesion with internal fat density, suggestive of a small adrenal adenoma.
Diffusely hypoattenuating liver, suggestive of diffuse hepatic steatosis, with a small area of focal fatty sparing around the gallbladder fossa.
Arrows in the reconstructed oblique and coronal planes point to an enlarged and thickened right Ductus deferens.
On the axial image, the right spermatic cord (yellow circle) is significantly thicker compared to the left side.
Green arrows in the last coronal image point to the bilaterally enlarged seminal vesicles with surrounding fat stranding.
Case Discussion
Bacterial prostatitis is usually the cause of seminal vesiculitis. Findings on imaging include enlargement and thickening of the seminal vesicles and prostate gland. After contrast administration (not in this case), diffuse enhancement is present.
These imaging findings fall under the spectrum of male accessory gland infections (MAGI).