SAR Prostate DFP – Teaching Case of the Week 10/21/19 … · 2019-10-23 · Rajan T. Gupta, M.D. Division Chief, Abdominal Imaging Director of Imaging, DCI Center for Prostate &

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