Diagnostic Ultrasound - Abdomen and Pelvis
Prostatic Carcinoma (Left) Transverse TRUS shows a hypoechoic left PZ lesion with capsular bulging and nodularity extending into the adjacent fat and left neurovascular bundle (NVB) . A smaller hypoechoic lesion is seen in the right PZ st. (Right) Corresponding Doppler ultrasound shows focal hypervascularity in the left PZ lesion. The right PZ lesion is mildly hypervascular st. Prostatectomy revealed multifocal PCa, including Gleason 5 + 5 adenocarcinoma with left extraprostatic extension and lymphovascular and perineural invasion. Diagnoses: Urinary Tract (Left) Transverse TRUS shows cranial extension of the hypoechoic right st and left PZ lesions into the base and seminal vesicles (SV) with left focal bulging and contour irregularity. (Right) Transverse TRUS, slightly higher at the level of the base and seminal vesicles, shows corresponding hypervascularity in abnormal hypoechoic regions in the right st and left PZ lesions & SV . Bilateral SV invasion was confirmed at prostatectomy. SV invasion (stage T3B) increases probability of recurrence after treatment. (Left) Transverse TRUS shows focal hypoechogenicity in the left PZ with mild bulging of the contour st. (Right) Corresponding color Doppler ultrasound shows focal hypervascularity in this region . Pathology from targeted biopsies of this region showed focal prostatitis. 531
Prostatic Carcinoma Diagnoses: Urinary Tract (Left) Heterogeneous T2 signal intensity is seen within the transition zone (TZ) with findings of glandular and stromal hyperplasia. The illdefined homogeneous T2 hypointense region on anterior TZ, consistent with "erased charcoal" sign, is seen. Note BPH nodule with a smoothly marginated T2 dark rim st uniformly T2-hyperintense PZ ſt and neurovascular bundles . (Right) Focal, ill-defined region of homogeneous T2 hypointensity in the anterior TZ corresponds to focal hypervascularity on the color map . (Left) Focal, ill-defined region of homogeneous T2 hypointensity and hypervascularity in the anterior TZ shows restricted diffusion . (Right) Corresponding low signal is shown on ADC map . Targeted MR-US fusion biopsy of this lesion showed Gleason 4 + 4 adenocarcinoma. (Left) Transverse TRUS shows a small, rounded, hypoechoic lesion in the left TZ . Targeted MR/US fusion biopsy of this lesion revealed benign tissue. Extensive PZ calcifications are present. (Right) Transverse TRUS in a different patient shows a larger hypoechoic lesion (outlined in red) within the left TZ. Pathology from a targeted MR/US fusion biopsy showed Gleason 4 + 5 adenocarcinoma. 532
- Page 502 and 503: Renal Abscess TERMINOLOGY Definitio
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- Page 506 and 507: Emphysematous Pyelonephritis (Left)
- Page 508 and 509: Pyonephrosis TERMINOLOGY Definition
- Page 510 and 511: Xanthogranulomatous Pyelonephritis
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Prostatic Carcinoma<br />
(Left) Transverse TRUS shows<br />
a hypoechoic left PZ lesion <br />
with capsular bulging <strong>and</strong><br />
nodularity extending into the<br />
adjacent fat <strong>and</strong> left<br />
neurovascular bundle (NVB)<br />
. A smaller hypoechoic<br />
lesion is seen in the right PZ<br />
st. (Right) Corresponding<br />
Doppler ultrasound shows<br />
focal hypervascularity in<br />
the left PZ lesion. The right PZ<br />
lesion is mildly hypervascular<br />
st. Prostatectomy revealed<br />
multifocal PCa, including<br />
Gleason 5 + 5 adenocarcinoma<br />
with left extraprostatic<br />
extension <strong>and</strong> lymphovascular<br />
<strong>and</strong> perineural invasion.<br />
Diagnoses: Urinary Tract<br />
(Left) Transverse TRUS shows<br />
cranial extension of the<br />
hypoechoic right st <strong>and</strong> left<br />
PZ lesions into the base<br />
<strong>and</strong> seminal vesicles (SV) with<br />
left focal bulging <strong>and</strong> contour<br />
irregularity. (Right) Transverse<br />
TRUS, slightly higher at the<br />
level of the base <strong>and</strong> seminal<br />
vesicles, shows corresponding<br />
hypervascularity in abnormal<br />
hypoechoic regions in the right<br />
st <strong>and</strong> left PZ lesions & SV<br />
. Bilateral SV invasion was<br />
confirmed at prostatectomy.<br />
SV invasion (stage T3B)<br />
increases probability of<br />
recurrence after treatment.<br />
(Left) Transverse TRUS shows<br />
focal hypoechogenicity in the<br />
left PZ with mild bulging of<br />
the contour st. (Right)<br />
Corresponding color Doppler<br />
ultrasound shows focal<br />
hypervascularity in this region<br />
. Pathology from targeted<br />
biopsies of this region showed<br />
focal prostatitis.<br />
531
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