1
|
Chan EEH, Li FX, Goh MCE, Sim SW. Spontaneous bilateral pampiniform plexus thrombosis in a teenager. BMJ Case Rep 2024; 17:e259222. [PMID: 38871644 DOI: 10.1136/bcr-2023-259222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024] Open
Abstract
Spontaneous pampiniform plexus thrombosis is an extremely rare condition. Its aetiology and pathophysiology are unknown, and its diagnosis remains challenging. We present the first case of an adolescent patient with bilateral spontaneous pampiniform plexus thrombosis. He presented with a 2-day history of bilateral testicular pain. Biochemical investigations were unremarkable, and the patient did not have any risk factors. Ultrasound of the scrotum demonstrated bilateral pampiniform plexus thrombosis. He was managed conservatively and repeat scrotal ultrasound 3 months later revealed complete resolution. This case adds to the minimal literature on spontaneous pampiniform plexus thrombosis, supporting diagnosis via scrotal ultrasound while recommending conservative management without the use of anticoagulation for patients with no pre-existing coagulopathy.
Collapse
Affiliation(s)
| | - Fay Xiangzhen Li
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | | | - Siam Wee Sim
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| |
Collapse
|
2
|
Ayed Alshahrani A. Unusual Case of Left Testicular Pain Due to Pampiniform Venous Plexus Thrombosis: A Case Report. Cureus 2023; 15:e51044. [PMID: 38264394 PMCID: PMC10805369 DOI: 10.7759/cureus.51044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2023] [Indexed: 01/25/2024] Open
Abstract
Spontaneous thrombosis of the pampiniform venous plexus is a rare phenomenon, with limited cases reported in the literature. Accurate diagnosis necessitates a high index of suspicion, and scrotal Doppler ultrasound proves to be an effective diagnostic tool. This case report aims to elucidate the diagnostic intricacies of spontaneous thrombosis of the left pampiniform venous plexus, emphasizing the pivotal role of scrotal Doppler ultrasound. Additionally, we explore successful treatment modalities, including anticoagulation and bed rest, leading to complete resolution. This contribution aims to enhance clinical understanding, particularly in outpatient and emergency care settings, where accurate and timely diagnosis is imperative.
Collapse
|
3
|
Gibson D, Zhong W, Bajaj M, Ranasinghe A. Segmental testicular infarction secondary to protein C deficiency. BMJ Case Rep 2023; 16:e255915. [PMID: 37914166 PMCID: PMC10626921 DOI: 10.1136/bcr-2023-255915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
Protein C deficiency is a rare blood disorder that increases the risk of thromboembolism, resulting in deep vein thrombosis, pulmonary embolisms and strokes. Segmental testicular infarction is also a rare condition with unclear aetiology. This case presents a man in his 50s with protein C deficiency who developed a segmental testicular infarction. The patient was managed conservatively, without surgical intervention. He was monitored with serial ultrasound, which demonstrated progression from normal testis to segmental infarction and eventually resolution. The case highlights that protein C deficiency can cause testicular infarction, and a multidisciplinary approach can help avoid unnecessary surgery with excellent outcomes. Segmental infarction should be considered in patients with pre-existing thrombophilias after excluding malignancy and infection. Conservative management with repeat ultrasonography and follow-up can be appropriate in such cases.
Collapse
Affiliation(s)
- Damien Gibson
- Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Urology, Saint George Hospital, Kogarah, New South Wales, Australia
| | - Wenjie Zhong
- Urology, Saint George Hospital, Kogarah, New South Wales, Australia
| | - Mohit Bajaj
- Urology, Saint George Hospital, Kogarah, New South Wales, Australia
| | - Anu Ranasinghe
- Urology, Saint George Hospital, Kogarah, New South Wales, Australia
| |
Collapse
|
4
|
Kolleri JJ, Abdirahman AM, Mahmood NS, Ladumor S, Hameed S. Spontaneous Bilateral Spermatic Vein Thrombosis: A Rare Clinical Presentation. Cureus 2021; 13:e20161. [PMID: 35003990 PMCID: PMC8723787 DOI: 10.7759/cureus.20161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2021] [Indexed: 11/24/2022] Open
Abstract
Cases of acute scrotum presenting to the emergency department are usually due to testicular torsion, complicated hernia, or epididymo-orchitis. Thrombosis of the spermatic vein is an uncommon entity and most of the cases reported to date are of unilateral involvement. Here, we present an extremely rare case of spontaneous bilateral spermatic vein thrombosis, which was diagnosed by a Doppler ultrasound of the testes. This article highlights its clinical presentation, radiological imaging, etiology, and management.
Collapse
|
5
|
Bennett L, March B, Whelan C, Lenton D. Acute testicular pain after laparoscopic appendicectomy: a rare case of provoked bilateral thrombosed varicoceles. ANZ J Surg 2021; 92:1558-1559. [PMID: 34723438 DOI: 10.1111/ans.17341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 10/09/2021] [Accepted: 10/19/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Laura Bennett
- Department of General Surgery, Orange Health Service, Orange, New South Wales, Australia
| | - Brayden March
- Department of Urology, Orange Health Service, Orange, New South Wales, Australia.,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Clair Whelan
- Department of Urology, Orange Health Service, Orange, New South Wales, Australia
| | - Doug Lenton
- Department of Haematology, Orange Health Service, Orange, New South Wales, Australia
| |
Collapse
|
6
|
The first report of a JAK2 V617F-positive myeloproliferative neoplasm with initial manifestation as a rare pampiniform venous plexus thrombosis and review of the literature. J Thromb Thrombolysis 2021; 53:213-217. [PMID: 34240279 DOI: 10.1007/s11239-021-02525-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
Pampiniform venous plexus (PVP) thrombosis is exceedingly rare, with fewer than 25 cases described. Thus, the etiology and pathophysiology remain largely unknown. A 38-year-old male with no known risk factors incidentally noted a 10-day history of right testicular discomfort prompting evaluation. Findings included extensive right PVP thrombus, critically elevated hematocrit, and a JAK2 V617F gene variant. Despite no treatment guidelines, conservative management was initiated with therapeutic apixaban, and therapeutic phlebotomy and hydroxyurea for newly diagnosed primary polycythemia vera (PV), sparing exploratory genitourinary surgery. This represents the first reported case of PVP thrombosis as the initial manifestation of a JAK2 V617F positive PV and the first documented report of PVP thrombosis associated with an acquired hypercoagulable state. Of the 8 previous cases with hypercoagulable testing performed, 2 involved inherited hypercoagulable states, suggesting hereditary and acquired prothrombotic disorders should be considered as predisposing factors. Testing for the JAK2 V617F variant in patients with mesenteric, cerebral, and splanchnic venous thromboses is currently recommended, but testing patients with venous thromboses in other anatomical locations remains controversial. We reviewed all previously described cases to expound upon this diagnosis, potential association with hypercoagulable disorders, treatment options, and observed clinical outcomes. This case adds to the minimal literature and supports genetic testing all patients with spontaneous PVP thrombosis for the JAK2 V617F variant and other hypercoagulable conditions. Additionally, conservative management with therapeutic anticoagulation and treatment of the underlying precipitating disease state may be acceptable in select patients, following exclusion of surgical emergencies.
Collapse
|
7
|
Right-sided varicocele thrombosis complicating an acute epididymo-orchitis: A case report and review of the literature. Urol Case Rep 2021; 39:101710. [PMID: 34221898 PMCID: PMC8243376 DOI: 10.1016/j.eucr.2021.101710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/06/2021] [Indexed: 12/04/2022] Open
Abstract
Unilateral right-sided varicocele is a rare and warning condition that should hint at a serious retroperitoneal disease such as renal cell neoplasm. Furthermore, its thrombosis is such an unusual entity that only a few cases have been described. We review the literature and report, to our knowledge, the second case of acute scrotal pain caused by unilateral right-sided varicocele thrombosis complicating an ipsilateral epididymo-orchitis, with no underlying coagulopathy or abdominal neoplasm, to illustrate the clinical, morphologic and therapeutic features of this entity.
Collapse
|
8
|
Nandy P, Kakria N, Singh G. Spontaneous Thrombosis of Varicocele: a Diagnostic Conundrum for an Acute Scrotum. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02757-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
9
|
Sieger N, Di Quilio F, Stolzenburg JU. What is beyond testicular torsion and epididymitis? Rare differential diagnoses of acute scrotal pain in adults: A systematic review. Ann Med Surg (Lond) 2020; 55:265-274. [PMID: 32547738 PMCID: PMC7283975 DOI: 10.1016/j.amsu.2020.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 05/19/2020] [Accepted: 05/19/2020] [Indexed: 11/06/2022] Open
Abstract
Background Acute scrotal pain is a urological emergency. While for testicular torsion and acute epididymitis clinical recommendations are well established, few is known about low incidence causes of acute scrotal pain. Our aim is to identify and characterise rare differential diagnoses of acute scrotal pain in order to give diagnostic and therapeutic recommendations. Materials and methods A systematic literature search was performed in PubMed, Web of Science and the Cochrane Library databases up to February 2019 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. The systematic review protocol was registered on PROSPERO (CRD42018099472). Results Eighty-four publications were selected for analysis. The databases provided mostly case reports, series and small studies, overall reporting on a cohort of 245 cases. Tumors, segmental testicular infarction, testicular vasculitis, pancreatitis, brucellosis, spermatic vein thrombosis, acute aortic syndrome and appendicitis were identified as rare underlying causes of acute scrotal pain and were characterised. As a result of our data analysis we were able to draw an overview of the rare differential diagnoses and diagnostic management of acute scrotal pain. Conclusion Rare differential diagnoses of acute scrotal pain are susceptible to misinterpretation as testicular torsion or acute epididymo-orchitis. Surgical management is indicated in case of suspicion for torsion or tumor. We herein present knowledge of the rare differential diagnoses and raise awareness for associated systemic disease in order to facilitate disease management and increase the potential for testicle-sparing treatment. First systematic approach to assess literature for rare differential diagnoses of acute scrotal pain. Disease characterization including sonographic features. Flow chart for the diagnostic and treatment options of acute scrotal pain beyond testicular torsion and common epididymo-orchitis.
Collapse
|
10
|
Bakshi S. Bilateral spontaneous thrombosis of the pampiniform plexus mimicking incarcerated inguinal hernia: case report of a rare condition and literature review. Surg Case Rep 2020; 6:47. [PMID: 32140844 PMCID: PMC7058780 DOI: 10.1186/s40792-020-00810-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 02/24/2020] [Indexed: 11/20/2022] Open
Abstract
Background Pampiniform plexus thrombosis is a very rare disease (only less than 25 published cases are available till date), and it is a diagnostic dilemma. The present case is an unusual condition of an elderly gentleman who was finally diagnosed as a case of spontaneous thrombosis of bilateral pampiniform plexus and was managed conservatively. Literature was reviewed to explore potential etiologies and therapeutic strategies. Case presentation A 65-year-old afebrile gentleman, laborer (in brick industry), and non-smoker with no previous major health problems was admitted with swelling in the bilateral inguinal region. The swelling had started one and half months ago. He had developed severe pain over the swelling for last 1 day with tenderness and indurations. Neither he had history of previous surgeries, chronic cough, dysuria, prostatism, and trauma nor he presented any thrombogenic factors. There was no history of vomiting, abdominal pain, and obstipation. Physical examination revealed normotensive person with BMI of 22.5, was significant only for one tender, movable, and firm to hard 10 cm × 3 cm mass extending from the left deep inguinal ring up to the upper pole of the testis in the scrotum. Another 5 cm × 3 cm mass of similar characteristics was found extending from deep inguinal ring up to the root of the scrotum on right side. The testes and prostate were normal on palpation. On the contrary to preoperative USG, which clinched suspicion of incarcerated inguinal hernia, a thrombosed pampiniform plexus without any evidence of hernia sac was found on the left side during inguino-scrotal exploration. Wound was closed without doing any further procedure. Contralateral inguino-scrotal exploration was spared considering same nature of disease. Postoperative Doppler ultrasonography confirmed the diagnosis of bilateral thrombosed pampiniform plexus. MDCT of whole abdomen revealed no abnormality other than bilateral spermatic cord thrombosis. Blood thrombophilia screening came normal. The subject had an uneventful postoperative hospital course. With 2 years of follow-up, the gentleman is doing well, remaining asymptomatic and had returned to his usual life. Conclusions Due to extreme rarity, spontaneous thrombosis of the pampiniform plexus may be a diagnostic dilemma and requires a high index of suspicion. Doppler ultrasound is the initial investigation of choice. In the absence of other concomitant disease, beginning the treatment conservatively instead of excising the thrombosed segment is more suitable.
Collapse
Affiliation(s)
- Sabyasachi Bakshi
- Department of General Surgery, BSMCH, Bankura, India. .,, Hooghly, 712103, West Bengal, India.
| |
Collapse
|
11
|
Lay Keat WO, Omar S, Pei Kwong H. Rare cause of acute scrotal swelling and pain in adult- a case report on spontaneous pampiniform plexus thrombosis and literature review. Urol Case Rep 2019; 28:101000. [PMID: 31832332 PMCID: PMC6889746 DOI: 10.1016/j.eucr.2019.101000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 08/11/2019] [Accepted: 08/13/2019] [Indexed: 11/25/2022] Open
Abstract
Acute scrotal pain is a common urological emergency where clinical judgement plays pivotal role in making the diagnosis. Scrotal pain secondary to spontaneous pampiniform plexus thrombosis is rare, and we are the first who report in the Asian region. A 50-year-old gentleman presented with left-sided scrotal pain & swelling. The diagnosis of pampiniform plexus thrombosis was confirmed by the ultrasound Doppler. He was treated with anticoagulant and good clinical result was obtained. Uncomplicated thrombosis could be managed non-surgically with good clinical outcome and radiological resolution. Ultrasound doppler remains first-line investigation to establish diagnosis, monitor the progression and treatment outcome.
Collapse
Affiliation(s)
| | - Shamsuddin Omar
- Department of Urology, Hospital Sultanah Aminah, Johor Bahru, Malaysia
| | | |
Collapse
|
12
|
Barkataki K, Wang N, Quesada D, O’Donnell R, Rosbrugh J, Aguìñiga-Navarrete P. Rare Cause of Inguinal Pain in 39-year-old Male. Clin Pract Cases Emerg Med 2019; 3:170-171. [PMID: 31061982 PMCID: PMC6497214 DOI: 10.5811/cpcem.2019.1.41212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 01/04/2019] [Accepted: 01/12/2019] [Indexed: 12/03/2022] Open
Affiliation(s)
- Kieron Barkataki
- Kern Medical, Department of Emergency Medicine, Bakersfield, California
| | - Nathan Wang
- Kern Medical, Department of Emergency Medicine, Bakersfield, California
| | - Daniel Quesada
- Kern Medical, Department of Emergency Medicine, Bakersfield, California; LAC+USC Medical Center, Department of Emergency Medicine, Los Angeles, California
| | - Rachell O’Donnell
- Kern Medical, Department of Emergency Medicine, Bakersfield, California
| | - James Rosbrugh
- Kern Medical, Department of Emergency Medicine, Bakersfield, California
| | | |
Collapse
|