Images 1-3: Prostatic nodules and abscesses can look similar sonographically. Power Doppler can assess if there is vascuklarity indicating a parenchymal lesion with blood supply. The image here has no blood supply and is power Doppler negative. Then a 22-gauge needle can be inserted first and aspirated to see if it is fluid filled or solid.
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Image 4: If the lesion is solid and no fluid is retrieved then a “Jab” or “woodpecker” technique may be utilized to perform an FNA for cytological analysis.
Image 5: If the hypoechoic lesion is fluid filled then it may be drained by ultrasound guided procedure.
Images 6-8: If the fluid appears flocculent or purulent then inserting a new needle attached to a syringe with enrofloxacin or similar antibiotic may be injected directly into the lesion. I use no more than a body weight dose of an antibiotic that fits the expected bacterial spectrum of the prostate and that technically could be injected IV. This procedure has never had complications and is currently under study for effectiveness. The resolution has been universally positive as long as neutering is performed at the same time and antibiotics are utilized over a 4 week postoperative period. Enrofloxacin +/- clindamycin is the combination we usually use orally for 4 weeks and followed by ultrasound recheck examination.
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This series is an example of a small prostatic abscess but this has also been utilized for large abscesses that have had early peritonitis as well with hospitalization and IV support in severe cases.
