A Case of Seminal Vesicle / Prostatic Reflux Causing Intense Focal Fluorodeoxyglucose Uptake in the Prostate Gland

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WH Ma, EYP Lee, ASH Lai, PL Khong

Hong Kong J Radiol 2016;19:49-51

DOI: 10.12809/hkjr1615333

We report an interesting case of benign persistent intense focal fluorodeoxyglucose (FDG) activity in the prostate gland. A 66-year-old man with a history of prostatism and benign prostate hypertrophy presented with elevated prostate-specific antigen. Three prostatic biopsies obtained by transrectal ultrasonography (TRUS) were negative for malignancy. Magnetic resonance imaging of the prostate revealed a hypointense signal at the right prostate base on T2-weighted images. FDG positron emission tomography/computed tomography (CT) was performed for further evaluation and demonstrated intense FDG activity, similar to urine, posterior to the prostate. Delayed CT scan showed serpiginous excretion of contrast into the seminal vesicles and peripheral zone of the prostate, corresponding to areas of intense and persistent FDG activity, compatible with seminal vesicle and prostatic reflux of urine resulting in intense FDG uptake. Awareness of this pathological entity that may be a complication of TRUS or due to chronic prostatitis may avoid misinterpretation, especially in the absence of administration of CT contrast to delineate the prostatic ducts.