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Huang DY, Alsadiq M, Yusuf GT, Deganello A, Sellars ME, Sidhu PS. Multiparametric Ultrasound for Focal Testicular Pathology: A Ten-Year Retrospective Review. Cancers (Basel) 2024; 16:2309. [PMID: 39001372 PMCID: PMC11240835 DOI: 10.3390/cancers16132309] [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] [Received: 03/21/2024] [Revised: 06/21/2024] [Accepted: 06/22/2024] [Indexed: 07/16/2024] Open
Abstract
Conventional ultrasonography (US), including greyscale imaging and colour Doppler US (CDUS), is pivotal for diagnosing scrotal pathologies, but it has limited specificity. Historically, solid focal testicular abnormalities often led to radical orchidectomy. This retrospective study evaluated the utilisation of contrast-enhanced ultrasound (CEUS) and strain elastography (SE) in investigating intratesticular focal abnormalities. A total of 124 cases were analysed. This study underscored the superior diagnostic capabilities of CEUS in detecting vascular enhancement in all malignant cases, even those with undetectable vascularity by CDUS. It also highlighted the potential of CEUS in identifying distinctive vascular patterns in benign vascular tumours. Definitive confirmation of benignity could be obtained when the absence of enhancement was demonstrated on CEUS. While SE alone offered no distinctive advantage in differentiating between benign and malignant pathologies, we demonstrated that incorporating a combination of CEUS and SE into the evaluation of focal testicular abnormalities could improve diagnostic performance metrics over conventional CDUS. Our findings underscore the role of advanced ultrasound techniques in enhancing the evaluation of focal testicular abnormalities in clinical practice and could aid a shift towards testis-sparing management strategies.
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Affiliation(s)
- Dean Y Huang
- Department of Clinical Radiology, King's College Hospital, London SE5 9RS, UK
- Department of Imaging Sciences, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London SE1 7EH, UK
| | - Majed Alsadiq
- Department of Imaging, The Royal London Hospital, London E1 1FR, UK
| | - Gibran T Yusuf
- Department of Clinical Radiology, King's College Hospital, London SE5 9RS, UK
- Department of Imaging Sciences, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London SE1 7EH, UK
| | - Annamaria Deganello
- Department of Clinical Radiology, King's College Hospital, London SE5 9RS, UK
- Department of Imaging Sciences, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London SE1 7EH, UK
| | - Maria E Sellars
- Department of Clinical Radiology, King's College Hospital, London SE5 9RS, UK
| | - Paul S Sidhu
- Department of Clinical Radiology, King's College Hospital, London SE5 9RS, UK
- Department of Imaging Sciences, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London SE1 7EH, UK
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2
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Kumar K, Kumari M, Kumar V, Suman SK. Evaluation of Scrotal Pathologies by Ultrasound and Color Doppler. Cureus 2023; 15:e36776. [PMID: 37123666 PMCID: PMC10133834 DOI: 10.7759/cureus.36776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2023] [Indexed: 03/30/2023] Open
Abstract
Introduction Due to its ease of use, lack of ionizing radiation exposure, noninvasive nature, reproducibility, low cost, and ease of accessibility, ultrasound (US) is the preferred imaging modality for evaluating scrotal disease. High-resolution US and color Doppler better highlight scrotal and testicular diseases because of the scrotum's superficial anatomy. The genital organs are subjected to damaging ionizing radiation during CT, while MRI is both costly and uncommon. Aims and objectives The aim of this study is to use ultrasonography (USG) to examine various scrotal diseases and to diagnose and identify different disorders utilizing high-resolution US and color Doppler. Materials and methods The study was done on 60 patients who were referred to the Department of Radiodiagnosis by the General Surgery and Urology departments for the scrotal US and Doppler study. This study was conducted between October 2021 and March 2022 at the Indira Gandhi Institute of Medical Sciences, Patna, India. Results Out of 60 patients, hydrocele was seen in 25 cases, scrotal hernia in 12 cases, undescended testis in eight cases, varicocele and epididymal cysts in seven cases, etc. In acutely painful scrotal disorders, high-frequency US with color Doppler sonography successfully distinguishes between testicular ischemia/torsion and acute inflammatory illnesses. Eighteen cases of inflammatory scrotal pathologies and one case of testicular torsion were seen. Conclusion In detecting and assessing scrotal diseases, high-frequency USG and color Doppler sonography have good sensitivity and specificity. Furthermore, the lack of ionizing radiation, simplicity, wide availability, cost-efficiency, and reproducibility make it a highly important method for scrotal diseases.
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3
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Belfield J, Findlay-Line C. Testicular Germ Cell Tumours—The Role of Conventional Ultrasound. Cancers (Basel) 2022; 14:cancers14163882. [PMID: 36010875 PMCID: PMC9405778 DOI: 10.3390/cancers14163882] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/04/2022] [Accepted: 08/10/2022] [Indexed: 11/16/2022] Open
Abstract
Testicular tumours are the most common tumours found in young males and germ cell tumours account for 95% of testicular tumours. Ultrasound is the first-line radiological investigation for imaging of the testis. This article outlines how to undertake an ultrasound examination, including optimal patient position, scanning technique and imaging parameters. Classification of germ cell tumours is provided, and salient imaging features of different tumours are described. Difficulties and pitfalls of ultrasound are described, including tumours found after a trauma presentation, orchitis causing diagnostic difficulties and imaging of small testicular lesions. Other uses of ultrasound are outlined, including looking for a primary testicular tumour following the discovery of retroperitoneal lymph nodes, imaging when tumour-makers increase, local recurrence in the scrotum, and for solid organ biopsy in metastatic disease. Conclusion: Ultrasound remains the first-line of investigation for imaging of the testis, and conventional ultrasound still plays a large role in imaging. On ultrasound alone, accurate morphological characterisation of tumours remains a challenge, despite the imaging features that can be seen in different tumour types. Therefore, histology following orchidectomy of a germ cell tumour remains the gold standard for accurate tumour characterisation.
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4
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Jo JI, Yang DM, Kim HC, Kim SW. Various Intratesticular Hypoechoic Lesions on Scrotal Sonography. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:861-875. [PMID: 36238913 PMCID: PMC9514578 DOI: 10.3348/jksr.2021.0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/04/2021] [Accepted: 09/27/2021] [Indexed: 06/16/2023]
Abstract
Sonography with a high-frequency transducer is the modality of choice for imaging the scrotum. Most intratesticular lesions are hypoechoic. Differentiation of intratesticular hypoechoic lesions as either malignant or benign is important because the treatment of these lesions vary. In this paper, we review the sonographic features of different types of intratesticular hypoechoic lesions, such as testicular cysts, testicular tumors, testicular inflammatory lesions, segmental testicular infarction, and testicular trauma.
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5
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Khatri G, Bhosale PR, Robbins JB, Akin EA, Ascher SM, Brook OR, Dassel M, Glanc P, Henrichsen TL, Learman LA, Sadowski EA, Saphier CJ, Wasnik AP, Maturen KE. ACR Appropriateness Criteria® Newly Diagnosed Palpable Scrotal Abnormality. J Am Coll Radiol 2022; 19:S114-S120. [PMID: 35550796 DOI: 10.1016/j.jacr.2022.02.018] [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] [Received: 02/15/2022] [Accepted: 02/19/2022] [Indexed: 11/29/2022]
Abstract
Palpable scrotal abnormalities are caused by a variety of disorders, ranging from indolent benign conditions to aggressive tumors, and infectious and vascular processes. In these patients the diagnostic workup typically begins with a complete clinical, history, and physical examinations, including analysis of risk factors. If imaging is required, ultrasound examination is the diagnostic modality of choice. In few select patients with very large scrotal masses, MRI may be appropriate. However, the use of gadolinium-based contrast should be evaluated critically depending on specific patient factors. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Gaurav Khatri
- Division Chief, Body MRI; Associate Division Chief, Abdominal Imaging; Program Director, Body MRI Fellowship, UT Southwestern Medical Center, Dallas, Texas.
| | | | | | - Esma A Akin
- George Washington University Hospital, Washington, District of Columbia
| | - Susan M Ascher
- Georgetown University Hospital, Washington, District of Columbia
| | - Olga R Brook
- Section Chief of Abdominal Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Mark Dassel
- Director Endometriosis and Chronic Pelvic Pain, Cleveland Clinic, Cleveland, Ohio; American College of Obstetricians and Gynecologists
| | - Phyllis Glanc
- University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Lee A Learman
- Dean, Virginia Tech Carilion School of Medicine, Roanoke, Virginia; American College of Obstetricians and Gynecologists
| | - Elizabeth A Sadowski
- University of Wisconsin, Madison, Wisconsin; and ACR O-RADS MRI Education Subcommittee Chair
| | - Carl J Saphier
- Women's Ultrasound, LLC, Englewood, New Jersey; American College of Obstetricians and Gynecologists
| | - Ashish P Wasnik
- Division Chief, Abdominal Radiology, University of Michigan, Ann Arbor, Michigan
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6
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Elmi AM, Kusbeci M, Osoble Osman FA. A case report of Fournier's gangrene: Imaging ultrasound and computed tomography (CT) scan. Radiol Case Rep 2022; 17:959-962. [PMID: 35106103 PMCID: PMC8784283 DOI: 10.1016/j.radcr.2021.12.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/30/2021] [Accepted: 12/30/2021] [Indexed: 11/24/2022] Open
Abstract
Necrotizing fasciitis and/or Fournier's Gangrene is a rare, life-threatening soft tissue infection that, if not treated promptly, can immediately develop into systemic toxicity. It affects the genital, perineal, and perineal tissues, predominantly affecting men but can be seen in women. The diagnosis is often made clinically but radiologic examinations are helpful to determine the extent of the infection and can aid preoperative planning. Treatment consists of immediate and aggressive surgical debridement of necrotized tissue, broad-spectrum antibiotics, and early resuscitation. Here, we present a 56-year-old male patient with Fournier's gangrene and describe the physical examination, bedside sonographic, and computed tomography findings. These findings can aid in the evaluation of patients with worrying symptoms so that antibiotics can be administered immediately and specialists can be consulted as needed.
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Affiliation(s)
- Abdinasir Mohamed Elmi
- Department of Radiology, Mogadishu Somali Turkey, Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia
| | - Mahmut Kusbeci
- Department of Radiology, Mogadishu Somali Turkey, Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia
| | - Faisal Abdi Osoble Osman
- Department of Radiology, Mogadishu Somali Turkey, Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia
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7
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Gupta A, Croake A, Rubens D, Dogra V. Do Not Get It Twisted: Common and Uncommon Manifestations of Testicular Torsion. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:271-283. [PMID: 33885184 DOI: 10.1002/jum.15723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 04/02/2021] [Indexed: 06/12/2023]
Abstract
Color flow and spectral Doppler ultrasound are the backbone of scrotal imaging when evaluating acute scrotal pain. Testicular Torsion is one of the most common causes of acute scrotal pain but can be a challenging diagnosis both clinically and sonographically. This article will review the pertinent Doppler ultrasound findings that can help make the diagnosis of both complete and partial torsion. A review of other causes of testicular ischemia will also be included as these pathologies can mimic Testicular Torsion.
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Affiliation(s)
- Akshya Gupta
- Department of Imaging Sciences, University of Rochester, Rochester, New York, USA
| | - Alexander Croake
- Department of Imaging Sciences, University of Rochester, Rochester, New York, USA
| | - Deborah Rubens
- Department of Imaging Sciences, University of Rochester, Rochester, New York, USA
| | - Vikram Dogra
- Department of Imaging Sciences, University of Rochester, Rochester, New York, USA
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8
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Tsili AC, Bougia CK, Pappa O, Argyropoulou MI. Ultrasonography of the scrotum: Revisiting a classic technique. Eur J Radiol 2021; 145:110000. [PMID: 34741987 DOI: 10.1016/j.ejrad.2021.110000] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/02/2021] [Accepted: 10/09/2021] [Indexed: 01/16/2023]
Abstract
Conventional US is the primary imaging modality for the evaluation of the scrotum, due to its high resolution, availability, cost-effectiveness and absence of ionizing radiation. Grayscale and color Doppler US provide a comprehensive assessment of scrotal diseases. The technique represents the mainstay for imaging of acute scrotum. US is highly accurate in the detection, localization and characterization of scrotal masses. Multiparametric US, including conventional US, contrast-enhanced US and tissue elastography has improved the diagnostic performance of the technique in the assessment of testicular diseases. MRI represents a valuable supplemental imaging tool for the investigation of scrotal pathology, mainly recommended in cases of indeterminate US findings. Recommendations recently issued by the European Society of Urogenital Radiology Scrotal and Penile Imaging Working Group (ESUR-SPIWG) refer to the use of scrotal sonography for the evaluation of pathologic entities, including testicular microlithiasis, small, non-palpable incidentally detected testicular masses, varicocele and scrotal trauma. In this review, the technical specifications for scrotal US and the normal sonographic findings are presented. Grayscale and color Doppler US findings of common acute scrotal diseases and scrotal masses are discussed. The complimentary role of multiparametric US and scrotal MRI is addressed. ESUR-SPIWG's guidelines are also reviewed.
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Affiliation(s)
- Athina C Tsili
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45110 Ioannina, Greece.
| | - Christina K Bougia
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45110 Ioannina, Greece
| | - Ourania Pappa
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45110 Ioannina, Greece
| | - Maria I Argyropoulou
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45110 Ioannina, Greece
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9
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Gupta A, Dogra V. Role of color flow Doppler ultrasound in the evaluation of acute scrotal pain. Andrology 2021; 9:1290-1297. [PMID: 34051064 DOI: 10.1111/andr.13058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 11/26/2022]
Abstract
Color flow Doppler ultrasound is a critical tool in the assessment of the scrotum. Ultrasound is the first-line imaging modality and can rapidly differentiate between surgical and nonsurgical conditions, allowing for appropriate and prompt patient management. We review the role of color flow Doppler in the evaluation of acute scrotal pain, highlighting some of the most commonly seen pathologies such as epididymo-orchitis and testicular torsion.
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Affiliation(s)
- Akshya Gupta
- Department of Imaging Sciences, University of Rochester, Rochester, New York, USA
| | - Vikram Dogra
- Department of Imaging Sciences, University of Rochester, Rochester, New York, USA
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10
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Asif AA, Shah N, McBee Orzulak FJ. Staphylococcus lugdunensis causing Epididymo-orchitis with scrotal pyocele. IDCases 2021; 24:e01142. [PMID: 33996467 PMCID: PMC8105631 DOI: 10.1016/j.idcr.2021.e01142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/21/2021] [Accepted: 04/21/2021] [Indexed: 11/24/2022] Open
Abstract
Staphylococcus lugdunensis, originally identified in 1988, is a coagulase negative staphylococcus (CNS) that has become a significant human pathogen. It has been found as a source of skin and soft tissue infection, endocarditis, urogenital tract infection, joint infection, and meningeal infection. Rarely, it manifests as scrotal infections or complications. Correct identification of the bacterial organism and prompt treatment is crucial in these cases, as delayed intervention can lead to complications requiring orchiectomy. We describe a rare case of a young male who presented with scrotal pain and swelling and was found to have epididymo-orchitis with scrotal pyocele on imaging. He underwent scrotal exploration with incision and drainage and did not require an orchiectomy. Wound cultures grew S. lugdunensis, and the patient clinically improved after being treated with appropriate antibiotics. To our knowledge, this is the first reported case of scrotal abscess and epididymo-orchitis with pyocele formation caused by S. lugdunensis.
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11
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AIUM Practice Parameter for the Performance of Scrotal Ultrasound Examinations. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:E30-E33. [PMID: 33660888 DOI: 10.1002/jum.15667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 06/12/2023]
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12
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Suciu MD, Marica NA, Oniu T, Tomuta AI, Badea R. Embryonal carcinoma of an intraabdominal testicular tumor on an undescended testicle: a case report. Med Pharm Rep 2020; 93:213-218. [PMID: 32478330 PMCID: PMC7243893 DOI: 10.15386/mpr-1293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 02/14/2020] [Accepted: 03/13/2020] [Indexed: 12/05/2022] Open
Abstract
Cryptorchidism, as a singular pathology or associated with other dysgenesis syndromes, is one of the main factors of risk for the development of the testicular tumors. Although there are a great number of cases of undescended testicles that are diagnosed and treated during the first 6-12 months of life, there are rare cases of adults who are undiagnosed and untreated from this anomaly, which can present a high risk of malignancy. In this study we present the case of a 36-year-old patient, diagnosed at puberty with left cryptorchidism, untreated, who also hadevidenced a large intraabdominal tumoral mass associated with it. The tumoral mass had its origin in the undescended left testicle. Surgical excision of the tumor and retroperitoneal lymphadenectomy was performed. The histological result revealed embryonal carcinoma, without lymphnode metastasis. Adult patients with untreated cryptorchidism should be thoroughly investigated, as they have a high risk of developing testicular cancer.
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Affiliation(s)
- Mihai Domnutiu Suciu
- Institute of Urology and Renal Transplantation, Cluj-Napoca, Romania
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Nucu Alexandru Marica
- Institute of Urology and Renal Transplantation, Cluj-Napoca, Romania
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | | | - Radu Badea
- Department of Medical Imaging, Iuliu Hatieganu University of Medicine and Pharmacy, "Prof. Dr. Octavian Fodor", Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Romania
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13
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Mondal K, Mandal R, Saha A, Shahabuddin MD, Sarkar R. Fine needle aspiration cytology of epididymal nodules and its corroboration with ultrasonographic‐histological findings. Diagn Cytopathol 2019; 48:118-127. [PMID: 31697443 DOI: 10.1002/dc.24336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 09/04/2019] [Accepted: 10/23/2019] [Indexed: 11/10/2022]
Affiliation(s)
| | - Rupali Mandal
- Department of PathologySonoscan Healthcare Malda West Bengal India
| | - Amitava Saha
- Department of PathologySonoscan Healthcare Malda West Bengal India
| | - MD Shahabuddin
- Department of PathologySonoscan Healthcare Malda West Bengal India
| | - Ranjan Sarkar
- Department of PathologySonoscan Healthcare Malda West Bengal India
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14
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Karavas E, Taydas O. Tunica albuginea cyst presenting with milk of calcium. Urol Ann 2019; 11:447-448. [PMID: 31649471 PMCID: PMC6798307 DOI: 10.4103/ua.ua_163_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Tunica albuginea cysts are rarely seen but are important and can be diagnosed easily with ultrasonography. Calcium milk is defined as the precipitation of calcium in a cyst or other fluid-containing structure and can be seen in many organs. In this case report, calcium milk seen in a tunica albuginea cyst is discussed.
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Affiliation(s)
- Erdal Karavas
- Department of Radiology, Erzincan Binali Yildirim University, Mengucek Gazi Training and Research Hospital, Erzincan, Turkey
| | - Onur Taydas
- Department of Radiology, Erzincan Binali Yildirim University, Mengucek Gazi Training and Research Hospital, Erzincan, Turkey
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15
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Pedersen MR, Bartlett EC, Brown C, Rafaelsen SR, Sellars ME, Sidhu PS. Is Testicular Macrocalcification a Risk for Malignancy?: Tumor Development on Ultrasonographic Follow-up of Preexisting Intratesticular Macrocalcification. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2949-2953. [PMID: 29665033 DOI: 10.1002/jum.14657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/20/2018] [Accepted: 03/22/2018] [Indexed: 06/08/2023]
Abstract
Testicular macrocalcification is an uncommon finding when imaging the scrotum with ultrasonography (US). It is not normally a recognized risk factor for development of testicular malignancy, and patients are not usually offered follow-up US examinations or counseled for self-examination. This aspect is in distinction to patients with testicular microlithiasis (usually with an additional risk factor), who are offered follow-up on the assumption that microlithiasis is associated with malignancy. We report a series of 6 patients with predetermined testicular macrocalcification, with development of a malignancy on follow-up US. We encourage US follow-up examinations for patients with macrocalcification, potentially in a similar manner as for those with testicular microlithiasis.
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Affiliation(s)
- Malene R Pedersen
- University of Southern Denmark, Institute of Regional Health Research, Odense, Denmark
- Department of Radiology, Vejle Hospital, Vejle, Denmark
| | - Emily C Bartlett
- Department of Radiology, King's College Hospital, King's College London, London, England
| | - Christian Brown
- Department of Urology, King's College Hospital, King's College London, London, England
| | - Søren R Rafaelsen
- University of Southern Denmark, Institute of Regional Health Research, Odense, Denmark
- Department of Radiology, Vejle Hospital, Vejle, Denmark
| | - Maria E Sellars
- Department of Radiology, King's College Hospital, King's College London, London, England
| | - Paul S Sidhu
- Department of Radiology, King's College Hospital, King's College London, London, England
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16
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Pedersen MR, Bartlett EC, Rafaelsen SR, Osther PJ, Vedsted P, Sellars ME, Sidhu PS, Møller H. Testicular microlithiasis is associated with ethnicity and socioeconomic status. Acta Radiol Open 2017; 6:2058460117723676. [PMID: 28815058 PMCID: PMC5546649 DOI: 10.1177/2058460117723676] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 07/10/2017] [Indexed: 11/23/2022] Open
Abstract
Background There are limited studies about testicular microlithiasis (TML) and background information such as health, lifestyle, and socioeconomic status. Purpose To assess the prevalence of TML in relation to socioeconomic status and ethnicity. Material and Methods From a database of scrotal ultrasound examinations in a single institution, all men who underwent routine ultrasound examinations for a variety of symptoms from 1998 to 2015 were included. Skilled observers performed all examinations, and presence of any form of intra-testicular calcification, including TML, was recorded on the examination report and a representative image obtained and stored. A total of 1105 cases with TML were reviewed and random sample of 1105 controls from the same database was also reviewed. Demographics were recorded including ethnicity (white, black, and others) and socioeconomic groups (IMD Quintile). Results Black men had increased prevalence of TML (odds ratio [OR] = 2.17, 95% confidence interval [CI] = 1.72–2.75) compared with white men. Among the 1105 TML cases, 423 (38.3%) were white, 273 (24.7%) black, 152 (13.8%) had other ethnicities, and 257 (23.2%) had no ethnicity recorded. In the control group of 1105 men without TML, 560 (50.7%) were white, 171 (15.5%) black, 111 (10.0%) had other specified ethnicities, and 263 (23.8%) had no ethnicity recorded. Men from the most deprived socioeconomic groups had higher prevalence of TML than men in the most affluent groups, with a trend in OR from the least deprived to the most deprived group. Conclusion Pathogenesis and clinical relevance of TML is unknown but our results point towards possible ethnic and socioeconomic variation in the underlying causes of TML.
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Affiliation(s)
- Malene R Pedersen
- Department of Radiology, Clinical Cancer Centre, Vejle Hospital - Part of Lillebaelt Hospital, Vejle, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Urological Research Center, Department of Urology, Vejle Hospital - Part of Lillebaelt Hospital, Denmark
| | | | - Søren R Rafaelsen
- Department of Radiology, Clinical Cancer Centre, Vejle Hospital - Part of Lillebaelt Hospital, Vejle, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Palle J Osther
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Urological Research Center, Department of Urology, Vejle Hospital - Part of Lillebaelt Hospital, Denmark
| | - Peter Vedsted
- Research Unit for General Practice, Department of Public Health, Aarhus University, Denmark.,Department of Clinical Medicine, Aarhus University, Denmark
| | - Maria E Sellars
- Department of Radiology, King's College Hospital, London, UK
| | - Paul S Sidhu
- Department of Radiology, King's College Hospital, London, UK
| | - Henrik Møller
- Research Unit for General Practice, Department of Public Health, Aarhus University, Denmark.,Cancer Epidemiology and Population Health, King's College London, London, UK
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Indra S, Kannikeswaran N, Arora R. A Case of Testicular Rupture Diagnosed by Point-of-Care-Ultrasound. Pediatr Emerg Care 2017; 33:516-518. [PMID: 28665898 DOI: 10.1097/pec.0000000000001192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Point-of-care ultrasound is an expanding diagnostic tool in the pediatric emergency department. We describe a case of testicular rupture diagnosed by ultrasound at the bedside, which led to prompt surgical intervention and repair.
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Affiliation(s)
- Sean Indra
- From the Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI
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18
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Bedayat A, Chen BY, Hayim M, Zheng L, Gagne SM, Mcintosh LJ, Deng AC, Lo HS. A Private Investigation: Radiologic-Pathologic Correlation of Testicular Tumors. Curr Probl Diagn Radiol 2017; 46:242-256. [DOI: 10.1067/j.cpradiol.2016.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 05/17/2016] [Indexed: 01/08/2023]
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19
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Kachramanoglou C, Rafailidis V, Philippidou M, Bertolotto M, Huang DY, Deganello A, Sellars ME, Sidhu PS. Multiparametric Sonography of Hematologic Malignancies of the Testis: Grayscale, Color Doppler, and Contrast-Enhanced Ultrasound and Strain Elastographic Appearances With Histologic Correlation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:409-420. [PMID: 28032907 DOI: 10.7863/ultra.16.02013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 05/06/2016] [Indexed: 06/06/2023]
Abstract
Primary testicular lymphoma is rare and appears with nonspecific findings on grayscale and color Doppler sonography. We present 8 patients further examined with contrast-enhanced sonography, strain elastography, and histologic analysis after orchiectomy. Seven of 8 patients had a diagnosis of large B-cell lymphoma, and 1 of 8 had a diagnosis of granulocytic sarcoma, with solitary lesions (2 of 8), multiple lesions (3 of 8), or entire testicular involvement (3 of 8). Lesions appeared hypoechoic (7 of 8) or isoechoic (1 of 8), all with increased vascularity on color Doppler sonography and a nonbranching linear pattern of intratumoral vessels (7 of 8). Contrast-enhanced ultrasound (CEUS) confirmed this pattern and showed increased enhancement in all lesions. On strain elastography, all lesions were hard, with an elasticity score of greater than 4. Multiparametric sonography of testicular lymphoma identifies increased vascularity on color Doppler and contrast-enhanced ultrasound and increased lesion stiffness on strain elastography.
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Affiliation(s)
| | | | | | | | - Dean Y Huang
- Department of Radiology, King's College Hospital, London, England
| | | | - Maria E Sellars
- Department of Radiology, King's College Hospital, London, England
| | - Paul S Sidhu
- Department of Radiology, King's College Hospital, London, England
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20
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Schröder C, Lock G, Schmidt C, Löning T, Dieckmann KP. Real-Time Elastography and Contrast-Enhanced Ultrasonography in the Evaluation of Testicular Masses: A Comparative Prospective Study. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:1807-1815. [PMID: 27181687 DOI: 10.1016/j.ultrasmedbio.2016.03.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 03/19/2016] [Accepted: 03/22/2016] [Indexed: 06/05/2023]
Abstract
This study investigates the usefulness of contrast-enhanced ultrasound (CEUS) and real-time elastography (RTE) for the characterization of testicular masses by comparing pre-operative ultrasound findings with post-operative histology. Sixty-seven patients with 68 sonographically detected testicular masses underwent B-mode, color-coded Doppler sonography (CCDS), CEUS and RTE according to defined criteria. For RTE, elasticity score (ES), difference of elasticity score (D-ES), strain ratio (SR) and size quotient (Qsize) were evaluated. Histopathologically, 54/68 testicular lesions were neoplastic (47 malignant, 7 benign). Descriptive statistics revealed the following results (neoplastic vs. non-neoplastic) for sensitivity, specificity, positive predictive value, negative predictive value and accuracy, respectively: B-mode, 100%, 43%, 87%, 100%, 88%; CCDS 81%, 86%, 96%, 55%, 82%; CEUS 93%, 85%, 96%, 73%, 91%; ES 98%, 25%, 85%, 75%, 85%; D-ES 98%, 50%, 90%, 83%, 89%; SR 90%, 45%, 86%, 56%, 81%; and Qsize 57%, 83%, 94%, 28%, 61%. B-mode with CCDS remains the standard for assessing testicular masses. In characterization of testicular lesions, CEUS clearly outperformed all other modalities. Our study does not support the routine use of RTE in testicular ultrasonography because of its low specificity.
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Affiliation(s)
- Claudia Schröder
- Department of Internal Medicine, Albertinen-Krankenhaus, Hamburg, Germany
| | - Guntram Lock
- Department of Internal Medicine, Albertinen-Krankenhaus, Hamburg, Germany.
| | - Christa Schmidt
- Department of Internal Medicine, Albertinen-Krankenhaus, Hamburg, Germany
| | - Thomas Löning
- Institute of Pathology, Albertinen-Krankenhaus, Hamburg, Germany
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21
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Imaging and angiography in male factor infertility. Fertil Steril 2016; 105:1432-42. [DOI: 10.1016/j.fertnstert.2016.04.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/06/2016] [Accepted: 04/07/2016] [Indexed: 02/07/2023]
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22
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Rafailidis V, Robbie H, Konstantatou E, Huang DY, Deganello A, Sellars ME, Cantisani V, Isidori AM, Sidhu PS. Sonographic imaging of extra-testicular focal lesions: comparison of grey-scale, colour Doppler and contrast-enhanced ultrasound. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2016; 24:23-33. [PMID: 27433272 DOI: 10.1177/1742271x15626195] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 12/13/2015] [Indexed: 12/27/2022]
Abstract
Extra-testicular lesions are usually benign but present with nonspecific grey-scale sonography findings. This study assesses conventional sonographic characteristics in the differentiation of extra-testicular tumoural from inflammatory lesions and whether contrast-enhanced ultrasound has a role. A retrospective database analysis was performed. All patients were examined by experienced sonographers employing standard techniques combining grey-scale, colour Doppler sonography and contrast-enhanced ultrasound. Features recorded were: clinical symptoms, size, location, echogenicity, colour Doppler sonography and contrast-enhanced ultrasound enhancement. Vascularity on colour Doppler sonography and contrast-enhanced ultrasound was graded and compared. The lesions were classified as tumoural or inflammatory. The Chi-square test was used to analyse the sonographic patterns and kappa coefficient to measure the agreement between colour Doppler sonography and contrast-enhanced ultrasound. A total of 30 lesions were reviewed (median diameter 12 mm, range 5-80 mm, median age 52 years, range 18-86 years), including 13/30 tumoural and 17/30 inflammatory lesions. Lesions were hypoechoic (n = 12), isoechoic (n = 6), hyperechoic (n = 2) or mixed (n = 10). Grey-scale characteristics of tumoural vs. inflammatory lesions differed significantly (P = 0.026). On colour Doppler sonography, lesions had no vessels (n = 16), 2-3 vessels (n = 10) and ≥4 vessels (n = 4). On contrast-enhanced ultrasound, lesions showed no vascularity (n = 17), perfusion similar to testis (n = 7) and higher (n = 6). All abscesses identified (n = 9) showed no vascularity on both colour Doppler sonography and contrast-enhanced ultrasound. There was good agreement between these techniques in evaluating vascularity (κ = 0.719) and no significant difference between colour Doppler sonography and contrast-enhanced ultrasound of tumoural vs. inflammatory lesions (P > 0.05). The grey-scale appearances of extra-testicular lesions are essential for characterisation. Colour Doppler sonography and contrast-enhanced ultrasound findings are not useful in that respect. Contrast-enhanced ultrasound is excellent in establishing absence of vascularity.
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Affiliation(s)
- Vasileios Rafailidis
- King's College London, Department of Radiology, King's College Hospital, Denmark Hill, London, UK
| | - Hasti Robbie
- King's College London, Department of Radiology, King's College Hospital, Denmark Hill, London, UK
| | - Eleni Konstantatou
- King's College London, Department of Radiology, King's College Hospital, Denmark Hill, London, UK
| | - Dean Y Huang
- King's College London, Department of Radiology, King's College Hospital, Denmark Hill, London, UK
| | - Annamaria Deganello
- King's College London, Department of Radiology, King's College Hospital, Denmark Hill, London, UK
| | - Maria E Sellars
- King's College London, Department of Radiology, King's College Hospital, Denmark Hill, London, UK
| | - Vito Cantisani
- Department of Radiology, Sapienza University of Rome, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Italy
| | - Paul S Sidhu
- King's College London, Department of Radiology, King's College Hospital, Denmark Hill, London, UK
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23
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Asymmetric spermatic cord vessel enhancement on CT: a sign of epididymitis or testicular neoplasm. ACTA ACUST UNITED AC 2015; 39:1014-20. [PMID: 24705669 DOI: 10.1007/s00261-014-0133-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To determine whether asymmetric spermatic cord vessel enhancement (ASE) on contrast-enhanced computed tomography (CECT) indicates scrotal pathology. METHODS Sixty-one male patients with scrotal symptoms who underwent both scrotal ultrasound (US) and CECT within 24 h were identified through a radiology information system. Twenty-eight emergency department patients who underwent CECT only for unrelated symptoms were included for comparison. Two blinded radiologists independently reviewed each CECT scan for qualitative ASE. These data were compared with US diagnoses, when present. A third blinded radiologist reviewed each CECT scan for quantitative ASE by measuring Hounsfield unit (HU) density ratios. McNemar, Kappa, Student's t test, and ANOVA were used for analysis. RESULTS Eighty-nine total patients included 28 with CECT only and 61 with CECT and US, of which 41 had abnormal US: 15 acute epididymitis and/or orchitis, 7 testicular neoplasms, 11 varicoceles, and 8 with other pathologies. Twenty patients with normal US and 28 patients with CECT only served as control groups. Identification of ASE agreed with US diagnosis of epididymitis (and/or orchitis) or testicular neoplasm (reader 1: κ = 0.79, reader 2: κ = 0.75) with average 95.5% sensitivity and 88.8% specificity, and no significant difference between readers (p = 0.58). For epididymitis (and/or orchitis) or testicular neoplasm patients, the average ratio of spermatic cord HU density (ipsilateral:contralateral) was significantly different from other patients (4.01 vs. 1.26, p = 0.0025). CONCLUSION ASE on CECT shows stronger correlation with epididymitis (and/or orchitis) and testicular neoplasm compared with other scrotal pathologies. If discovered on CECT, this should prompt further clinical and/or imaging workup.
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Abstract
Management of testicular seminoma has benefited from numerous advances in imaging, radiotherapy, and chemotherapy over the last 50 years leading to nearly 100% disease-specific survival for low-stage seminoma. This article examines the evaluation and management of low-stage testicular seminoma, which includes clinical stage I and IIA disease. Excellent outcomes for stage I seminoma are achieved with active surveillance, adjuvant radiotherapy, and adjuvant single-agent carboplatin. Current areas of research focus on optimizing surveillance regimens and minimizing the morbidity and long-term complications of adjuvant treatment. Radiotherapy continues to be the primary treatment option for patients with clinical stage IIa disease.
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Affiliation(s)
- Shane M Pearce
- Section of Urology, Department of Surgery, University of Chicago, 5841 South Maryland Avenue, MC 6038, Chicago, IL 60637, USA.
| | - Stanley L Liauw
- Department of Radiation and Cellular Oncology, University of Chicago, 5841 South Maryland Avenue, MC 6038, Chicago, IL 60637, USA
| | - Scott E Eggener
- Section of Urology, Department of Surgery, University of Chicago, 5841 South Maryland Avenue, MC 6038, Chicago, IL 60637, USA
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25
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Harlequin testicle and other uncommon pathologies masquerading at routine scrotal ultrasound. Ultrasound Q 2015; 31:109-16. [PMID: 25938549 DOI: 10.1097/ruq.0000000000000143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Many scrotal conditions manifest similarly as pain, swelling, a palpable abnormality, or a combination of these symptoms. Most common scrotal pathologies have characteristic accompanying sonographic findings. Less common pathologies can have similar clinical presentations, and imaging with scrotal ultrasound is required to aid in proper diagnosis. This article focuses on several of these less commonly encountered scrotal pathologies--including testicular segmental infarction, scrotal filariasis, scrotal mesothelioma, seminiferous tubule fibrosis, and scrotal leiomyosarcoma--and compares and contrasts them to more routine diagnoses. Familiarity with both typical and atypical scrotal conditions is necessary to make accurate diagnoses at ultrasound to guide appropriate treatment and avoid unnecessary surgery.
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26
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Di Serafino M, Gullotto C, Gregorini C, Nocentini C. A clinical case of Fournier's gangrene: imaging ultrasound. J Ultrasound 2014; 17:303-6. [PMID: 25368689 PMCID: PMC4209220 DOI: 10.1007/s40477-014-0106-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 03/17/2014] [Indexed: 10/25/2022] Open
Abstract
Fournier's gangrene is a rapidly progressing necrotizing fasciitis involving the perineal, perianal, or genital regions and constitutes a true surgical emergency with a potentially high mortality rate. Although the diagnosis of Fournier's gangrene is often made clinically, emergency ultrasonography and computed tomography lead to an early diagnosis with accurate assessment of disease extent. The Authors report their experience in ultrasound diagnosis of one case of Fournier's gangrene of testis illustrating the main sonographic signs and imaging diagnostic protocol.
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Affiliation(s)
- Marco Di Serafino
- />U.O. Radiodiagnostica P.O. Santa Maria alla Gruccia Azienda USL8 Arezzo, zona Valdarno, p.zza del Volontariato 2, 52025 Montevarchi, AR Italy
| | - Chiara Gullotto
- />U.O. Pronto Soccorso, DEA P.O. Santa Maria alla Gruccia Azienda USL8 Arezzo, zona Valdarno, Montevarchi, Italy
| | - Chiara Gregorini
- />U.O. Radiodiagnostica P.O. Santa Maria alla Gruccia Azienda USL8 Arezzo, zona Valdarno, p.zza del Volontariato 2, 52025 Montevarchi, AR Italy
| | - Claudia Nocentini
- />U.O. Radiodiagnostica P.O. Santa Maria alla Gruccia Azienda USL8 Arezzo, zona Valdarno, p.zza del Volontariato 2, 52025 Montevarchi, AR Italy
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28
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Condorelli R, Calogero AE, La Vignera S. Relationship between Testicular Volume and Conventional or Nonconventional Sperm Parameters. Int J Endocrinol 2013; 2013:145792. [PMID: 24089610 PMCID: PMC3780703 DOI: 10.1155/2013/145792] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Accepted: 08/02/2013] [Indexed: 11/17/2022] Open
Abstract
Background. Reduced testicular volume (TV) (<12 cm(3)) is associated with lower testicular function. Several studies explored the conventional sperm parameters (concentration, motility, and morphology) and the endocrine function (gonadotropins and testosterone serum concentrations) in the patients with reduction of TV. No other parameters have been examined. Aim. This study aims at evaluating some biofunctional sperm parameters by flow cytometry in the semen of men with reduced TV compared with that of subjects with normal TV. Methods. 78 patients without primary scrotal disease were submitted to ultrasound evaluation of the testis. They were divided into two groups according to testicular volume: A Group, including 40 patients with normal testicular volume (TV > 15 cm(3)) and B Group, including 38 patients with reduced testicular volume (TV ≤ 12 cm(3)). All patients underwent serum hormone concentration, conventional and biofunctional (flow cytometry) sperm parameters evaluation. Results. With regard to biofunctional sperm parameters, all values (mitochondrial membrane potential, phosphatidylserine externalization, chromatin compactness, and DNA fragmentation) were strongly negatively correlated with testicular volume (P < 0.0001). Conclusions. This study for the first time in the literature states that the biofunctional sperm parameters worsen and with near linear correlation, with decreasing testicular volume.
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Affiliation(s)
- Rosita Condorelli
- Section of Endocrinology, Andrology and Internal Medicine, Department of Medical and Pediatric Sciences, University of Catania, Policlinico “G. Rodolico”, Via S. Sofia 78, Building 4, Room 2C19, 95123 Catania, Italy
| | - Aldo E. Calogero
- Section of Endocrinology, Andrology and Internal Medicine, Department of Medical and Pediatric Sciences, University of Catania, Policlinico “G. Rodolico”, Via S. Sofia 78, Building 4, Room 2C19, 95123 Catania, Italy
| | - Sandro La Vignera
- Section of Endocrinology, Andrology and Internal Medicine, Department of Medical and Pediatric Sciences, University of Catania, Policlinico “G. Rodolico”, Via S. Sofia 78, Building 4, Room 2C19, 95123 Catania, Italy
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29
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Doherty MH, Gerscovich EO, Corwin MT, Wilkendorf SR. Methamphetamine use can mimic testicular torsion. JOURNAL OF CLINICAL ULTRASOUND : JCU 2013; 41:461-463. [PMID: 23606543 DOI: 10.1002/jcu.22049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 12/04/2012] [Accepted: 02/28/2013] [Indexed: 06/02/2023]
Abstract
We report the case of a patient presenting with the classic clinical appearance of testicular torsion. Ultrasound showed testicular ischemia supporting the clinical diagnosis, but the lack of visualization of spermatic cord torsion was of concern. An attempt of clinical detorsion was considered unsuccessful and the patient was explored. No torsion was found. On postoperative review of the patient's medical history, we found methamphetamine use, with a positive urine test at the time of his emergent consultation for the scrotal pain episode. The use of amphetamines has been previously reported as the cause of ischemia of multiple organs, but we could not find previous reports of involvement of the testis mimicking torsion.
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Affiliation(s)
- Michael H Doherty
- University of California, Davis School of Medicine, 4860 Y Street, Suite 3100, Sacramento, CA 95817, USA
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30
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Increased Lymphocyte Concentration in the Semen of Patients with Reduced Testicular Volume. EUR J INFLAMM 2013. [DOI: 10.1177/1721727x1301100318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Low testicular volume (TV) is associated with a decreased testicular function. Several studies explored the conventional sperm parameters and the endocrine function in patients with low TV. No other parameters have been examined. On the basis of these premises, the aim of this study was to evaluate a non-conventional seminal parameter: seminal lymphocyte characterisation in men with low TV compared with that of subjects with normal TV. A further comparison was made between fertile men and infertile patients with low or normal TV (78 patients). The testis was considered normal in size when it had a volume between 15 and 25 cm3, low-normal with a volume between 10 and 12 cm3 and hypotrophic when the volume was <10 cm3. Statistically significant differences were observed in the following sperm parameters: percentage of immature germ elements, peroxidase-positive leukocyte concentration and CD45pos leukocytes (p<0.05). A correlation analysis showed the presence of a positive linear relationship between CD45pos leukocytes and the percentage of immature germ elements (r=0.88; p<0.05) and between CD45pos leukocytes and the percentage of spermatozoa with phosphatidylserine externalisation (r=0.90; p<0.05) as well as a negative linear relationship between the percentage of spermatozoa with normal morphology and the seminal CD45pos leukocyte concentration (r=-0.75; p<0.05). The results of this study showed that patients with low testicular volume (<10 cm3) have a significantly increased CD45pos concentration that is associated with increased percentages of immature germ elements, spermatozoa with signs of early apoptosis, and spermatozoa with abnormal morphology.
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Urologic manifestations of inflammatory pseudotumor: Report of 2 cases and review of the literature. Radiol Case Rep 2012; 7:742. [PMID: 27326307 PMCID: PMC4899702 DOI: 10.2484/rcr.v7i3.742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
We report two adult patients with varied urologic symptoms who were found to have inflammatory pseudotumor on histopathology. The first patient had a large, solid, enhancing retroperitoneal mass lesion and presented with increased frequency of urination and recurrent urinary tract infections. The second patient had an obstructing left distal ureteric stricture and presented with painless hematuria. Though preoperative radiological diagnosis of this entity is not feasible, the present article illustrates the imaging findings in this unusual disease entity with review of the relevant literature.
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