CASE 617: PROSTATE on SWE TRUS with BIPLAN PROBE, Dr NGUYEN MINH THIEN, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Male patient 64yo with fever and voiding discomfort for month.

Digital rectal examination detected a big prostate with a hard nodule on right side.

On MRI there were a 22x15mm hard node of right lobe and another one, 12x16mm, on the left of prostate which concern neoplastic foci , but  PSA=1.75 ng/mL;  F/T=20%

At Medic, an SWE elastography TRUS with biplane probe was done

On TRUS B-mode,  peripheral area of right lobe exists a 16x18 mm hypoechoic nodule, not well-limited,  hypervascular and irregular capsule of right lobe.

On strain elastography, nodule is harder than transitional area while surrounded area of right lobe is softer than the nodule.

On 2D SWE, stiffness of nodule on right side has got a value of 50 kPa [mild hard] while lesion of transitional area of left lobe of 47 kPa.

By via  transperineal a biopsy of prostate was perfomed and histopathological result is TB of prostate and subacute prostatitis.

Conclusion: 

SWE TRUS with biplan probe helps imaging lesions of prostate with more  information to plan for treatment better.

CASE 616: INFECTED SCROTAL SKIN, Dr LE TU PHUC, Dr LE VAN TAI, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

A 74-year-old male patient presented to our clinic because of pain and swelling in the right scrotum for 10 days. The scrotum became larger, harder and pus drained out of the scrotum about 3 days before the ultrasound examination.

About 3 months ago, he underwent transurethral resection of the prostate (TURP) and was infected with COVID-19 in the postoperative period. After the COVID isolation, the patient did not show any symptoms of infection.

On ultrasound of the scrotum, we found scrotal edema, thickening, interstitial fluid and gas between the scrotal skin layers. Gas spreads anteriorly to the right pubic tubercle and posteriorly to the base of the penis near the anus.

Gas was not seen in the left scrotum, in the spermatic cord, in the skin of the abdomen and on the buttocks and thighs. No fistula from the rectum was found.

Due to the patient's recent urinary tract surgery, urinary catheterization, history of diabetes, gas and fluid in the right scrotal skin. We therefore assumed diagnosis of Fournier's gangrene.

The paitent was transferred to surgery department after and treated with debridement surgery in combination with antibacterial and detoxification therapy. He improve well till now.

Getting well at hospital discharge.