Computed tomography imaging analysis of hematogenous disseminated pulmonary tuberculosis cases combined with prostate tuberculosis

Abstract

Objective: The aim of this study is to enhance the understanding of prostate tuberculosis by analyzing clinical data and prostate computed tomography (CT) imaging of patients with hematogenous disseminated pulmonary tuberculosis and prostate tuberculosis.

Methods: Patients with hematogenous disseminated pulmonary tuberculosis and prostate tuberculosis admitted to Kunming Third People's Hospital between January 2018 and December 2024 were enrolled in the study. Their clinical and imaging characteristics were retrospectively analyzed.

Results: A cohort of 11 male patients were included in the study, with only 4 (36.4%) experiencing scrotal swelling and pain. All 11 patients (100.0%) had positive γ-interferon release assay results. More than 90% exhibited a decreased absolute value and percentage of peripheral blood lymphocytes, lower serum albumin and prealbumin levels, elevated C-reactive protein, and an increased erythrocyte sedimentation rate. CT images of prostate tuberculosis predominantly revealed multiple hypodense shadows in the prostate, while contrast-enhanced scans demonstrated annular enhancement or significant enhancement of prostate tissue outside the lesion. Following effective anti-tuberculosis treatment, follow-up CT scans showed lesion size reduction, decreased enhancement around the hypodense lesion, and the emergence of punctate and sand-like calcifications. If tuberculosis involved other organs of the male reproductive system, corresponding CT findings were also observed.

Conclusion: Hematogenous disseminated pulmonary tuberculosis with concurrent prostate tuberculosis is often associated with other extrapulmonary tuberculosis and tuberculosis affecting organs of the reproductive system. Clinical symptoms are generally mild. CT imaging plays a significant role in diagnosing and monitoring this condition.

Keywords: Male genital; Multidetector computed tomography; Prostate; Pulmonary; Tuberculosis.

Fig. 1

A-B Case 1, a patient diagnosed with hematogenous disseminated pulmonary tuberculosis, prostate tuberculosis, intracranial tuberculosis, intestinal tuberculosis, and osteoarticular tuberculosis. A: An abdominal non-contrast scan reveals a single slightly hypodense shadow on the left side of the prostate with unclear boundaries (white arrow). B: During the portal venous phase of the contrast-enhanced scan, annular enhancement of the lesion margins can be observed (white arrow). C-D Case 3, a patient with hematogenous disseminated pulmonary tuberculosis, prostate tuberculosis, seminal vesicle tuberculosis, intracranial tuberculosis, peritoneal tuberculosis, and renal tuberculosis. C: An abdominal non-contrast scan demonstrates multiple slightly hypodense shadows in the prostate with unclear boundaries (white arrow). D: During the contrast-enhanced portal venous phase, no enhancement is seen in the hypodense shadows on the non-contrast scan, while the surrounding prostate tissue exhibits significant enhancement (white arrow). E-F Case 4, a patient diagnosed with hematogenous disseminated pulmonary tuberculosis, prostate tuberculosis, seminal vesicle tuberculosis, epididymal tuberculosis, and testicular tuberculosis. E: An abdominal contrast-enhanced scan in the delayed phase sagittal reconstruction demonstrates filling of hyperdense contrast agent in the bladder (hollow white arrow), multiple hypodense shadows in the prostate (black arrow), and filling of contrast medium in the upper segment of the prostatic urethra (white arrow). F: The abdominal contrast-enhanced scan in the delayed phase coronal reconstruction demonstrates similar findings, with the contrast agent filling the bladder (hollow white arrow), multiple hypodense shadows in the prostate (black arrow), and the contrast medium in the upper segment of the prostatic urethra, which deviates locally to the right (white arrow)

Fig. 2

Case 2, patient diagnosed with hematogenous disseminated pulmonary tuberculosis, prostate tuberculosis, seminal vesicle tuberculosis, vas deferens tuberculosis, intracranial tuberculosis, osteoarticular tuberculosis, peritoneal tuberculosis, and splenic tuberculosis. A: The initial contrast-enhanced abdominal CT scan reveals a round hypodense shadow on the left side of the prostate, with significant annular enhancement surrounding it (white arrow). B: The contrast-enhanced abdominal CT scan, reviewed 3 months after anti-tuberculosis treatment, demonstrates a round hypodense shadow on the left side of the prostate with mild enhancement around it. The lesion size has decreased, the boundary enhancement has weakened, and the range of enhancement has been reduced (white arrow). C: The contrast-enhanced abdominal CT scan, conducted 6 months after anti-tuberculosis treatment, reveals a round hypodense shadow on the left side of the prostate, with further reduction in the lesion size and no surrounding enhancement (white arrow). D: The contrast-enhanced abdominal CT scan, performed 9 months after anti-tuberculosis treatment, demonstrates a round hypodense shadow on the left side of the prostate, with further reduction in the lesion size and no enhancement surrounding it (white arrow)

Fig. 3

Time series plots of the maximum axial diameter of the largest lesion in 6 patients

Fig. 4

Case 7, a patient, diagnosed with hematogenous disseminated pulmonary tuberculosis, prostate tuberculosis, seminal vesicular tuberculosis, vas deferens tuberculosis, epididymal tuberculosis, intracranial tuberculosis, intestinal tuberculosis, peritoneal tuberculosis, and renal tuberculosis. A: The contrast-enhanced abdominal scan during the portal venous phase reveals significant enlargement of both seminal vesicles (white arrows) with uneven enhancement. B Case 10, patient diagnosed with hematogenous disseminated pulmonary tuberculosis, prostate tuberculosis, seminal vesicular tuberculosis, vas deferens tuberculosis, epididymal tuberculosis, testicular tuberculosis, intracranial tuberculosis, osteoarticular tuberculosis, and renal tuberculosis. The contrast-enhanced abdominal scan during the portal venous phase demonstrates significant thickening at the beginning of the right vas deferens, with the thickened vas deferens wall demonstrating significant enhancement (white arrow). C Case 10, patient diagnosed with hematogenous disseminated pulmonary tuberculosis, prostate tuberculosis, seminal vesicular tuberculosis, vas deferens tuberculosis, epididymal tuberculosis, and peritoneal tuberculosis. The contrast-enhanced abdominal scan during the portal venous phase demonstrates annular enhancement of the left cauda epididymis (white arrow) and annular enhancement in the right testicle (black arrow)