SAR Prostate DFP – Teaching Case of the Week 10/21/19 … · 2019-10-23 · Rajan T. Gupta, M.D....
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URINARY-PUBIC SYMPHYSIS FISTULA WITH PUBIC OSTEOMYELITIS IN TREATED PROSTATE CANCER PATIENTS Rajan T. Gupta, M.D. SAR Prostate DFP – Teaching Case of the Week 10/21/19
Transcript of SAR Prostate DFP – Teaching Case of the Week 10/21/19 … · 2019-10-23 · Rajan T. Gupta, M.D....
URINARY-PUBICSYMPHYSISFISTULAWITHPUBIC
OSTEOMYELITISINTREATEDPROSTATECANCERPATIENTS
RajanT.Gupta,M.D.
SARProstateDFP–TeachingCaseoftheWeek10/21/19
� 74yowithGleason3+4prostatecancer� Treatmentcourse
� ExternalbeamradiaMontherapy(EBRT)approximately20yearsprior
� SubsequentsalvagecryoablaMonandandrogendeprivaMontherapy(ADT)forlocaltumorrecurrence
� PaMentpresentedwithpelvicpain� PelvicMRIwasperformed
History
CasecourtesyofRajanT.Gupta,MD;DukeUniversityMedicalCenter
CasecourtesyofRajanT.Gupta,MD;DukeUniversityMedicalCenter
T1WIwithoutFS
� AbnormalT1hypointensesignalinpubicsymphysiswithcorMcaldestrucMon(arrows)andfistulatrackingthroughthepubicsymphysis(arrowhead)
MRIInterpretaMon
CasecourtesyofRajanT.Gupta,MD;DukeUniversityMedicalCenter
CasecourtesyofRajanT.Gupta,MD;DukeUniversityMedicalCenter
AxT2WIwithFS
CasecourtesyofRajanT.Gupta,MD;DukeUniversityMedicalCenter
CoronalT2WIwithFS
� Fluidtrackingfromurinarybladderthroughthepubicsymphysisàfistula(arrowhead)
MRIInterpretaMon
CasecourtesyofRajanT.Gupta,MD;DukeUniversityMedicalCenter
� éT2signalinadjacentparasymphysealpubicrami(arrows)extendinginferiorlyàosteomyeliMs
MRIInterpretaMon
CasecourtesyofRajanT.Gupta,MD;DukeUniversityMedicalCenter
� PubicboneosteomyeliMswithpubicsymphysis-urinaryfistula� RareanddifficulttotreatcomplicaMonaZer
radiaMonand/orablaMvetherapiesforprostatecancer
� TypicallypresentsaspersistentornewpubicorsuprapubicpainmonthsaZertreatment
� MRIcanbehelpfultodetectandcharacterize
TeachingPoints
CasecourtesyofRajanT.Gupta,MD;DukeUniversityMedicalCenter
� OsteomyeliMsMRIfindings:� IntramedullaryêT1WI&éT2WIandpost-contrast
enhancement
� MRIfindingsuniquetothiscondiMon:� MajoritywithafocalfluidcollecMon(typically
parasymphysealorperiprostaMc)
� ~50%withfistulanearorthroughpubicsymphysis
TeachingPoints
CasecourtesyofRajanT.Gupta,MD;DukeUniversityMedicalCenter
� FormoreinformaMon:
� SextonSJ,LavienG,SaidN,EwardW,PetersonAC,GuptaRT.AbdomRadiol2019;44(4);1453-1460.
� PMID30460532
TeachingPoints
CasecourtesyofRajanT.Gupta,MD;DukeUniversityMedicalCenter
� TheodoraA.Potretzke,M.D.� AdamT.Froemming,M.D.� StephanieSexton,M.D.� GarjaeLavien,M.D.� NicholasSaid,M.D.,M.B.A.� WilliamEward,M.D.� AndrewC.Peterson,M.D.
Acknowledgments
CasecourtesyofRajanT.Gupta,MD;DukeUniversityMedicalCenter
THANKYOU
RajanT.Gupta,M.D.DivisionChief,AbdominalImaging
DirectorofImaging,DCICenterforProstate&UrologicCancersAssociateProfessorofRadiology&Surgery
DukeUniversityMedicalCenter&[email protected]▪@RajanTGuptaMD
SARProstateDFP–TeachingCaseoftheWeek10/21/19
