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Jaweesh S, Jaweesh M, Mahgaa MT, Ali S, Alfandi A, Mahmoud MZ. Diagnosis and management of a rare case of encysted hydrocele of spermatic cord: Case report and literature review. Int J Surg Case Rep 2024; 115:109299. [PMID: 38277986 PMCID: PMC10839639 DOI: 10.1016/j.ijscr.2024.109299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 01/28/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE A hydrocele is typically a non-cancerous condition that arises from the accumulation of fluid between the layers of the vaginal process. Diagnosis primarily involves a physical examination. In instances where the condition is mistaken for other pathological conditions, additional investigations may be undertaken. Surgical intervention is typically deferred until after the age of one year, unless the hydrocele is significantly large. CASE PRESENTATION A case was presented of a 4-year-old boy who was referred to the hospital with a suspected deep inguinal hernia. Upon examination, it was determined that the mass was actually an encysted hydrocele of spermatic cord. The patient underwent a minimally invasive surgery to remove the spermatocele, and the procedure was successful. CLINICAL DISCUSSION This emphasizes the importance of obtaining a detailed patient history and conducting a comprehensive physical examination, which often provide sufficient information to make a diagnosis. In many instances, these initial steps can spare patients from undergoing additional tests that may be invasive or pose unnecessary risks. CONCLUSION It is important to note that in cases of hydroceles, conservative treatment, such as observation, is the primary approach before the age of one year. Surgery is typically reserved for older children or those with large hydroceles.
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Affiliation(s)
- Shkri Jaweesh
- Faculty of Medicine, Al-Sham Private University, Damascus, Syria.
| | | | | | - Sanaa Ali
- Faculty of Medicine, Al-Sham Private University, Damascus, Syria
| | - Abdullah Alfandi
- Faculty of Medicine, Al-Sham Private University, Damascus, Syria
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Huayanay Espinoza JL, Espinoza Figueroa JVJ, Velezmoro Díaz VE, Huanca Amesquita LS, Cruz Baca RC, Rioja Vega MA, Guelfguat M. Soft-Tissue Sarcomas of the Genitourinary Tract with Radiologic-Pathologic Correlation. Radiographics 2024; 44:e230138. [PMID: 38236750 DOI: 10.1148/rg.230138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Genitourinary tract soft-tissue sarcomas are rare neoplasms with varied pathologic and clinical features. While some of these tumors may be aggressive high-grade malignancies, others are low grade with a relatively better prognosis. Given that the grade and extent of the disease are important prognostic factors in these tumors, timely diagnosis is crucial. Unfortunately, most imaging features of these malignancies are not pathognomonic, and various histologic subtypes do not manifest with typical classic imaging features. Therefore, reliable differentiation of the various histologic tumor types is not always possible based solely on the radiologic manifestations. Imaging findings need to be considered in the context of clinical history in corroboration with radiologic-pathologic correlation. The authors discuss the specific imaging and pathologic characteristics of various genitourinary tract soft-tissue sarcomas, emphasizing diagnostic difficulties and differential diagnoses. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
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Affiliation(s)
- Jorge L Huayanay Espinoza
- From the Departments of Radiology (J.L.H.E., J.V.J.E.F., V.E.V.D.) and Pathology (L.S.H.A., R.C.C.B., M.A.R.V.), Instituto Nacional de Enfermedades Neoplásicas, Av Angamos 2520 Surquillo, 15038 Lima, Peru; and Department of Radiology, Jacobi Medical Center, Bronx, NY (M.G.)
| | - Jossue V J Espinoza Figueroa
- From the Departments of Radiology (J.L.H.E., J.V.J.E.F., V.E.V.D.) and Pathology (L.S.H.A., R.C.C.B., M.A.R.V.), Instituto Nacional de Enfermedades Neoplásicas, Av Angamos 2520 Surquillo, 15038 Lima, Peru; and Department of Radiology, Jacobi Medical Center, Bronx, NY (M.G.)
| | - Vanessa E Velezmoro Díaz
- From the Departments of Radiology (J.L.H.E., J.V.J.E.F., V.E.V.D.) and Pathology (L.S.H.A., R.C.C.B., M.A.R.V.), Instituto Nacional de Enfermedades Neoplásicas, Av Angamos 2520 Surquillo, 15038 Lima, Peru; and Department of Radiology, Jacobi Medical Center, Bronx, NY (M.G.)
| | - Lourdes S Huanca Amesquita
- From the Departments of Radiology (J.L.H.E., J.V.J.E.F., V.E.V.D.) and Pathology (L.S.H.A., R.C.C.B., M.A.R.V.), Instituto Nacional de Enfermedades Neoplásicas, Av Angamos 2520 Surquillo, 15038 Lima, Peru; and Department of Radiology, Jacobi Medical Center, Bronx, NY (M.G.)
| | - Renier C Cruz Baca
- From the Departments of Radiology (J.L.H.E., J.V.J.E.F., V.E.V.D.) and Pathology (L.S.H.A., R.C.C.B., M.A.R.V.), Instituto Nacional de Enfermedades Neoplásicas, Av Angamos 2520 Surquillo, 15038 Lima, Peru; and Department of Radiology, Jacobi Medical Center, Bronx, NY (M.G.)
| | - Marco A Rioja Vega
- From the Departments of Radiology (J.L.H.E., J.V.J.E.F., V.E.V.D.) and Pathology (L.S.H.A., R.C.C.B., M.A.R.V.), Instituto Nacional de Enfermedades Neoplásicas, Av Angamos 2520 Surquillo, 15038 Lima, Peru; and Department of Radiology, Jacobi Medical Center, Bronx, NY (M.G.)
| | - Mark Guelfguat
- From the Departments of Radiology (J.L.H.E., J.V.J.E.F., V.E.V.D.) and Pathology (L.S.H.A., R.C.C.B., M.A.R.V.), Instituto Nacional de Enfermedades Neoplásicas, Av Angamos 2520 Surquillo, 15038 Lima, Peru; and Department of Radiology, Jacobi Medical Center, Bronx, NY (M.G.)
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Charlaix Hidalgo AL, Roux A, Charissoux A, Mathonnet M, Descazeaud A, Durand Fontanier S, Taibi A. First Case of Abdominal and Tunica Vaginalis Multicystic Benign Mesothelioma: Management and Review of Literature. Indian J Surg Oncol 2023; 14:92-96. [PMID: 37359917 PMCID: PMC10284750 DOI: 10.1007/s13193-022-01693-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 12/22/2022] [Indexed: 01/05/2023] Open
Abstract
Multicystic benign mesothelioma is a rare tumor that affects the serosa. Most cases present with peritoneal lesions exclusively. Some identified risk factors are chronic abdominal inflammation, woman of childbearing age, and asbestos exposure. The symptomatology is not specific and can delay the diagnosis. There are no guidelines for the treatment of this pathology. We describe one male patient with abdominal and tunica vaginalis localizations of multicystic benign mesothelioma. The diagnosis was suspected on imaging and confirmed with histological examination. The treatment on an expert center was complete cytoreduction surgery and HIPEC, but the patient had two recurrences during the 2-year of follow-up. This is the first case of simultaneous rare localizations of multicystic benign mesothelioma. No new risk factors were identified. The case underlines the importance of regular examination of all serosa localizations.
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Affiliation(s)
| | - Alexia Roux
- Digestive Surgery Department, Dupuytren Limoges University Hospital, Limoges, France
| | - Aurelie Charissoux
- Pathology Department, Dupuytren Limoges University Hospital, Limoges, France
| | - Muriel Mathonnet
- Digestive Surgery Department, Dupuytren Limoges University Hospital, Limoges, France
| | - Aurelien Descazeaud
- Urology Surgery Department, Dupuytren Limoges University Hospital, Limoges, France
| | - Sylvaine Durand Fontanier
- Digestive Surgery Department, Dupuytren Limoges University Hospital, Limoges, France
- University Limoges, CNRS, XLIM, 7252, F-87000 Limoges, UMR France
| | - Abdelkader Taibi
- Digestive Surgery Department, Dupuytren Limoges University Hospital, Limoges, France
- University Limoges, CNRS, XLIM, 7252, F-87000 Limoges, UMR France
- Visceral Surgery Department, Limoges University Hospital, Limoges, France
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Gabriel H, Hammond NA, Marquez RA, Lopes Vendrami C, Horowitz JM, Casalino DD, Nikolaidis P, Miller FH, Bhatt S. Gamut of Extratesticular Scrotal Masses: Anatomic Approach to Sonographic Differential Diagnosis. Radiographics 2023; 43:e220113. [PMID: 36893051 DOI: 10.1148/rg.220113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
The commonly taught tenet that intratesticular lesions are always malignant and extratesticular scrotal lesions are always benign is a simplistic statement that erroneously minimizes the significance of extratesticular scrotal masses and their diagnosis. Yet, disease in the extratesticular space is commonly encountered by clinicians and radiologists and is often a source of uncertainty in diagnosis and management. Given the embryologically rooted complex anatomy of this region, a wide range of pathologic conditions is possible. Radiologists may not be familiar with some of these conditions; further, many of these lesions can have a specific sonographic appearance, allowing accurate diagnosis that can minimize surgical intervention. Lastly, malignancies can occur in the extratesticular space-although this is less common than in the testicles-and proper recognition of findings that warrant additional imaging or surgery is critical in optimizing outcomes. The authors present a compartmental anatomic framework for differential diagnosis of extratesticular scrotal masses and provide a comprehensive illustrative display of many of the pathologic conditions that can be encountered to familiarize radiologists with the sonographic appearances of these lesions. They also review management of these lesions and scenarios where US may not be definitive in diagnosis and selective use of scrotal MRI can be helpful. © RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Helena Gabriel
- From the Department of Radiology, Northwestern University, 676 N St. Clair St, Suite 800, Chicago, IL 60611 (H.G., N.A.H., R.A.M., C.L.V., J.M.H., D.D.C., P.N., F.H.M.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
| | - Nancy A Hammond
- From the Department of Radiology, Northwestern University, 676 N St. Clair St, Suite 800, Chicago, IL 60611 (H.G., N.A.H., R.A.M., C.L.V., J.M.H., D.D.C., P.N., F.H.M.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
| | - Rocio A Marquez
- From the Department of Radiology, Northwestern University, 676 N St. Clair St, Suite 800, Chicago, IL 60611 (H.G., N.A.H., R.A.M., C.L.V., J.M.H., D.D.C., P.N., F.H.M.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
| | - Camila Lopes Vendrami
- From the Department of Radiology, Northwestern University, 676 N St. Clair St, Suite 800, Chicago, IL 60611 (H.G., N.A.H., R.A.M., C.L.V., J.M.H., D.D.C., P.N., F.H.M.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
| | - Jeanne M Horowitz
- From the Department of Radiology, Northwestern University, 676 N St. Clair St, Suite 800, Chicago, IL 60611 (H.G., N.A.H., R.A.M., C.L.V., J.M.H., D.D.C., P.N., F.H.M.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
| | - David D Casalino
- From the Department of Radiology, Northwestern University, 676 N St. Clair St, Suite 800, Chicago, IL 60611 (H.G., N.A.H., R.A.M., C.L.V., J.M.H., D.D.C., P.N., F.H.M.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
| | - Paul Nikolaidis
- From the Department of Radiology, Northwestern University, 676 N St. Clair St, Suite 800, Chicago, IL 60611 (H.G., N.A.H., R.A.M., C.L.V., J.M.H., D.D.C., P.N., F.H.M.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
| | - Frank H Miller
- From the Department of Radiology, Northwestern University, 676 N St. Clair St, Suite 800, Chicago, IL 60611 (H.G., N.A.H., R.A.M., C.L.V., J.M.H., D.D.C., P.N., F.H.M.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
| | - Shweta Bhatt
- From the Department of Radiology, Northwestern University, 676 N St. Clair St, Suite 800, Chicago, IL 60611 (H.G., N.A.H., R.A.M., C.L.V., J.M.H., D.D.C., P.N., F.H.M.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
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A population-based evaluation of tunica vaginalis mesothelioma: An analysis of the National Cancer Database. Urol Oncol 2023; 41:52.e11-52.e20. [PMID: 36319552 DOI: 10.1016/j.urolonc.2022.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/14/2022] [Accepted: 09/30/2022] [Indexed: 11/08/2022]
Abstract
PURPOSE Primary mesothelioma of the tunica vaginalis (TVM) is a rare and poorly understood malignancy with insufficient population-level data to guide management decisions. MATERIALS AND METHODS A retrospective analysis of TVM cases recorded in the National Cancer Database from 2004 to 2015 was performed. Cases were identified using International Classification of Diseases for Oncology histology codes. Associations between demographic, clinical and therapeutic factors were analyzed using Kaplan-Meier survival estimates for overall survival (OS) and Cox proportional hazard modeling. Propensity score matching for receipt of systemic chemotherapy was performed to assess the impact on OS. RESULTS One hundred fifty-one men with a median age of 65 years (interquartile range [IQR] 51-78) were included. Median OS from diagnosis was 72.5 months (IQR 20.2-Not Reached [NR]) after a median follow up of 34.9 months. Multivariate analysis demonstrated an increased risk of death for patients in the fourth quartile of age (hazard ratio [HR] 5.57, 95% confidence interval [CI] 1.70-18.17, P = 0.004), those with biphasic or fibrous histology (HR 2.59, 95% CI 1.15-6.42, P = 0.04) and positive surgical margins (HR 3.27, 95% CI 1.61-6.63, P = 0.001). There was no significant difference in OS associated with receiving chemotherapy (P = 0.5) even after propensity score matching (P = 0.07). CONCLUSIONS Margin-negative surgical resection is paramount to improving OS. There are insufficient data to recommend for or against adjuvant systemic chemotherapy or RT, although the limited available data does not suggest apparent benefit in terms of OS.
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Cheng CQ, Sun J, Yin JY, Wang TT, He XM. Ultrasonography of a giant adenomatoid tumor of the tunica vaginalis: A case report and review of the literature. Radiol Case Rep 2022; 17:4302-4307. [PMID: 36132067 PMCID: PMC9483582 DOI: 10.1016/j.radcr.2022.08.027] [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: 04/06/2022] [Revised: 08/07/2022] [Accepted: 08/10/2022] [Indexed: 10/31/2022] Open
Abstract
Adenomatoid tumor is a kind of benign tumor, accounts for a low percentage of scrotal tumors. It usually locates in epididymis, less commonly, arises from the tunica albuginea, spermatic cord or tunica vaginalis of male's urogenital tract system. Here, we report a case of a 32-year-old male, which presented as a 6-month history of left scrotal swelling pain with a scrotal mass, and it had progressively enlarged over the last 1 month. The ultrasonography (US) described a giant well-defined hypoechoic mass in the left scrotum, a thick pedicle connected the mass and the left scrotal wall, and the pedicle had large blood vessels in it. Enhanced CT showed an irregular solid mass in the left scrotum, the left testicular artery was thickened to supply blood for the mass, and the radiologist mentioned it could not be excluded as a malignant lesion. The patient underwent left radical orchiectomy, the mass was diagnosed as an adenomatoid tumor of the tunica vaginalis by pathology. We review literature regarding adenomatoid tumors originating in the tunica vaginalis, summarize the ultrasonographic presentations, provide the idea of diagnosis and differential diagnosis to improve diagnostic accuracy and avoid unnecessary orchiectomy.
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Karbasian N, Segaran N, Solomon N, Pellerito JS, Katz DS, Moshiri M, Revzin MV. Pathologic Conditions at Imaging of the Spermatic Cord. Radiographics 2022; 42:741-758. [PMID: 35394888 DOI: 10.1148/rg.210161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A wide range of benign and malignant processes can affect the spermatic cord (SC). Familiarity with and recognition of the characteristic imaging features of these entities are imperative for accurate diagnosis and optimal clinical care. While some SC diseases are self-limiting, others can result in infertility and potentially life-threatening infection or bleeding if they are left untreated. Therefore, correct diagnosis is important for life-saving treatment and preservation of fertility. Disorders including anomalies of the vas deferens and the processus vaginalis, arterial and venous diseases (torsion of the SC and varicoceles), infection, trauma, and neoplasms are the most pertinent entities with which radiologists should be familiar when assessing the SC. Knowing what to expect in a patient who has undergone SC interventions is imperative. US has a fundamental role in the initial examination of patients who present with symptoms that indicate abnormalities of the SC, such as suspected posttraumatic testicular retraction or SC torsion. Other imaging techniques including abdominal and pelvic MRI and CT have their own importance. For correct interpretation of the findings and to establish an accurate diagnosis, it is crucial to have a thorough knowledge of the anatomy, the utility and limitations of various imaging modalities, optimal imaging and scanning techniques, and the imaging features of various benign and malignant pathologic conditions that can involve the SC. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Niloofar Karbasian
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.K., N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Zucker School of Medicine at Hofstra/Northwell, Department of Radiology, Northwell Health System, Manhasset, NY (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, NY (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.M.)
| | - Nicole Segaran
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.K., N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Zucker School of Medicine at Hofstra/Northwell, Department of Radiology, Northwell Health System, Manhasset, NY (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, NY (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.M.)
| | - Nadia Solomon
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.K., N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Zucker School of Medicine at Hofstra/Northwell, Department of Radiology, Northwell Health System, Manhasset, NY (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, NY (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.M.)
| | - John S Pellerito
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.K., N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Zucker School of Medicine at Hofstra/Northwell, Department of Radiology, Northwell Health System, Manhasset, NY (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, NY (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.M.)
| | - Douglas S Katz
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.K., N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Zucker School of Medicine at Hofstra/Northwell, Department of Radiology, Northwell Health System, Manhasset, NY (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, NY (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.M.)
| | - Mariam Moshiri
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.K., N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Zucker School of Medicine at Hofstra/Northwell, Department of Radiology, Northwell Health System, Manhasset, NY (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, NY (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.M.)
| | - Margarita V Revzin
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.K., N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Zucker School of Medicine at Hofstra/Northwell, Department of Radiology, Northwell Health System, Manhasset, NY (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, NY (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.M.)
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Ravikanth R. Acquired encysted hydrocele of the cord secondary to trauma in a child: Sonological appearances of a rare entity. J Med Ultrasound 2022; 30:65-66. [PMID: 35465593 PMCID: PMC9030356 DOI: 10.4103/jmu.jmu_73_20] [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: 05/09/2020] [Revised: 06/30/2020] [Accepted: 07/06/2020] [Indexed: 11/25/2022] Open
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Mirjalili SAM, Maleki H, Gholami J. Testis with no tunica vaginalis: A case report and literature review. Int J Reprod Biomed 2021; 19:851-852. [PMID: 34723065 PMCID: PMC8548749 DOI: 10.18502/ijrm.v19i9.9718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 08/02/2020] [Accepted: 02/08/2021] [Indexed: 12/02/2022] Open
Affiliation(s)
| | - Hadi Maleki
- Department of Urology, Shahid Madani Hospital, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Javid Gholami
- Urologist Gonbad Kavus Hospital, Golestan University of Medical Science, Gorgan, Iran
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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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He TQ, Zhu LH, Li CY, Peng QL, Zu JC, Liu Y, Zhao YW. Clinical Analysis of Pyocele of Tunica Vaginalis in 56 Newborns. Urol Int 2021; 106:700-705. [PMID: 34638122 DOI: 10.1159/000519096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/11/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study aimed to explore the clinical characteristics, treatment methods, and prognosis of neonatal pyocele of tunica vaginalis and to provide a reference for the clinical treatment. METHODS A total of 56 newborns with pyocele of tunica vaginalis were admitted to our hospital due to the scrotal emergency from January 2015 to January 2020. Our study retrospectively analyzed these 56 cases. Of the 56 cases, including 32 full-term infants and 24 premature infants, age ranged from 1 to 27 days. Initially, conservative treatment (intravenous antibiotic treatment) was applied to 42 cases, and surgery to 14 cases. Then, 7 underwent surgical exploration during the conservative treatment, and 2 cases with initial surgical treatment experienced orchiectomy because of complete necrosis. For 56 cases, the average follow-up time was 18 months. RESULTS The clinical recovery time of cases with conservative treatment ranged from 8 to 17 days, with an average of 11.02 ± 2.31 days. The clinical recovery time of cases with surgery ranged from 6 to 15 days, with an average of 9.28 ± 2.78 days. During the follow-up, for 56 cases, except for the 2 cases with orchiectomy, the testicular position and Doppler flow both went back to normal, of the 42 cases with initial conservative treatment, 1 case experienced testicular retardation, of the 14 cases with initial surgical treatment, 2 cases experienced testicular retardation, and hydrocele of 42 cases were self-healed. CONCLUSIONS Neonatal pyocele of tunica vaginalis is mostly secondary to intra-abdominal infection. Color Doppler ultrasound is helpful for the diagnosis. The percutaneous aspiration is a way of collecting pathogenic bacteria during the conservative treatment. If the color Doppler suggests testicular involvement, surgical exploration should be performed.
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Affiliation(s)
- Tian-Qu He
- Department of Urology, Hunan Children's Hospital, Changsha, China
| | - Li-Hui Zhu
- Department of Nursing, Hunan Children's Hospital, Changsha, China
| | - Chuang-Ye Li
- Department of Urology, Hunan Children's Hospital, Changsha, China
| | - Qian-Long Peng
- Department of Urology, Hunan Children's Hospital, Changsha, China
| | - Jian-Cheng Zu
- Department of Urology, Hunan Children's Hospital, Changsha, China
| | - Yu Liu
- Department of Urology, Hunan Children's Hospital, Changsha, China
| | - Yao-Wang Zhao
- Department of Urology, Hunan Children's Hospital, Changsha, China
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12
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Yu L, Chen P, Zhu W, Sun J, Li S. Case Report:clinical experience of bilateral giant pediatric Testicular adrenal rest tumors with 3 Beta-Hydroxysteroid Dehydrogenase-2 family history. BMC Pediatr 2021; 21:405. [PMID: 34526000 PMCID: PMC8440148 DOI: 10.1186/s12887-021-02883-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/08/2021] [Indexed: 11/26/2022] Open
Abstract
Background We reported a patient with Testicular adrenal rest tumors(TARTs) caused by congenital adrenal hyperplasia(CAH). TARTs occur frequently in CAH population with 21-hydroxylase deficiency(21-OHD). There are few reports of TARTs with 3β-hydroxysteroid dehydrogenase deficiency-2 (3β-2HSD).Furthermore,gaint TARTs are rarely mentioned in reported cases involving affected siblings. Case presentation A 14-year-old male patient was admitted by congenital adrenal hyperplasia with progressively increasing bilateral testicular masses.The Patient and his elder brother had been performed mutational and chromosome analysis and biopsy. Hormonal and anthropometric measurements were performed during endocrine treatments. We successfully performed surgery and excised two 83mm×46mm×44mm and 74mm×49mm×31mm tumors. Our pathology and immunochemistry tests have proven TARTs in patient. At first, both siblings received regular doses of hydrocortisone and fludrocortisones and tumor size regressed. During the one-year irregular intake due to Covid-19 pandemic, endocrine treatment became insensitive and tumor size slowly increased. The gene analysis reported two novel mutations C.776 C>T and C.674 T>A. The C.776 C>T is from father and has been reported. The C.674 T>A inherited from mother and cannot found in gene library and may related to TARTs. Conclusions This case illustrates inadequate hormone therapy could cause tumor enlargement. It is essential to seek for ultrasound examination once suspected scrotal mass occurred.It is necessary to adjust endocrine medicine or adopt surgery in refractory gaint TARTs. And presence of tunica vaginalis cavity may indicate the severity of TARTs in surgery. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02883-x.
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Affiliation(s)
- Lingyun Yu
- Department of Urology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Pengyu Chen
- Department of Urology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Wenbin Zhu
- Department of Urology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Junjie Sun
- Department of Urology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Shoulin Li
- Department of Urology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China.
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Tang C, Chen CT, Hung CH, Wang YC. Acute Scrotum Secondary to Torsion of a Tunica Vaginalis Cyst. Urology 2020; 144:e1-e3. [PMID: 32683065 DOI: 10.1016/j.urology.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/27/2020] [Accepted: 07/05/2020] [Indexed: 11/27/2022]
Abstract
This is a case of an 8-year-old boy with a chief complaint of left-lower-quadrate abdominal pain for 3 days. Examination revealed swollen left hemi-scrotum and scrotal ultrasound showed a para-testicular cystic mass, which was later proven to be a torsion of a benign scrotal tunica cyst during emergent scrotal exploration. Torsion of the tunica vaginalis cyst is a rare cause of acute scrotum, and we present this case to share our experience of diagnosis and management of this peculiar disease.
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Affiliation(s)
- Chin Tang
- Division of Urology, Department of Surgery, Cathay General Hospital, Taipei, Taiwan
| | - Chung-Tso Chen
- Division of Urology, Department of Surgery, Cathay General Hospital, Taipei, Taiwan
| | - Chi-Hsuan Hung
- Division of Urology, Department of Surgery, Cathay General Hospital, Taipei, Taiwan
| | - Yen-Chieh Wang
- Division of Urology, Department of Surgery, Cathay General Hospital, Taipei, Taiwan; School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan.
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14
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Hannappel TD, DeVries MJ, Hansen NJ. Imaging appearance of cystic and solid mesothelioma of the tunica vaginalis. Radiol Case Rep 2020; 15:809-811. [PMID: 32346459 PMCID: PMC7182692 DOI: 10.1016/j.radcr.2020.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 12/02/2022] Open
Abstract
We present the case of a 32-year-old male who presented with a growing scrotal mass initially diagnosed as benign adenomatoid tumor on ultrasound 6 years prior. Repeat ultrasound showed an abnormal extra-testicular mass with nodular and cystic components and internal vascularity. A computed tomography scan of the abdomen and pelvis confirmed a right extra-testicular scrotal mass with cystic and solid enhancing components. The patient underwent radical orchiectomy and postoperative pathology diagnosed mesothelioma of the tunica vaginalis of the testis. Mesothelioma of the tunica vaginalis of the testis is an exceptionally rare disease. We discuss the risk factors, imaging features, and treatment strategies of the disease.
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Affiliation(s)
| | - Matthew J DeVries
- University of Nebraska Medical Center, Omaha, NE, USA.,Department of Radiology, 981045 Nebraska Medical Center, Omaha, NE 68198-1045, USA
| | - Neil J Hansen
- University of Nebraska Medical Center, Omaha, NE, USA.,Department of Radiology, 981045 Nebraska Medical Center, Omaha, NE 68198-1045, USA
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15
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Brainwood M, Beirne G, Fenech M. Persistence of the processus vaginalis and its related disorders. Australas J Ultrasound Med 2020; 23:22-29. [PMID: 34760578 DOI: 10.1002/ajum.12195] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The processus vaginalis is a blind-ended evagination of the abdominal wall that develops during fetal life and typically undergoes obliteration in early life. Persistence of the processus vaginalis is associated with a number of pathologies including congenital indirect inguinal hernias, communicating hydroceles, funicular and encysted hydroceles, canal of Nuck cysts, and acquired undescended testis. Whilst all are detectable sonographically, there is little educational material relevant to the field of ultrasound with much of the literature directed at surgical and primary care physicians. Furthermore, within the literature there is a lack of consensus on several areas including the anatomy and embryology of the processus vaginalis and the mechanisms behind its obliteration. As such the objective of this paper is to distil the information regarding the persistent processus vaginalis as it is relevant to ultrasound and in doing so address the literature gap for sonographers and sonologists. The anatomy and embryology of the persistent processus vaginalis will be discussed including causative mechanisms for anomalies with their sonographic appearance highlighted.
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Affiliation(s)
- Michelle Brainwood
- Department of Ultrasound Qscan Radiology Clinics College Junction 2-12 Wagner Road Clayfield Queensland 4011 Australia
| | - Geraldene Beirne
- Locum Senior Sonographer Matraville New South Wales 2036 Australia
| | - Michelle Fenech
- School of Health, Medical and Applied Sciences Central Queensland University 160 Ann Street Brisbane Queensland 4000 Australia
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16
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Smereczyński A, Kołaczyk K. Differential diagnosis of fat-containing lesions in the inguinal canal using ultrasound. J Ultrason 2019; 19:222-227. [PMID: 31807328 PMCID: PMC6856773 DOI: 10.15557/jou.2019.0033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 07/19/2019] [Indexed: 12/05/2022] Open
Abstract
Abdominal hernias are usually located in the inguinal canals. Differential diagnosis of hernias should consider other pathologies, which typically occur at this site. The aim of this review paper is to present fat-containing lesions located in the inguinal canal based on both our own experience and literature. The first part of the paper describes the embryogenesis and differences in the structure and content of male and female inguinal canal. The canal is clearly wider in men, which results from the presence of the spermatic cord and its components. The female canal contains only the narrow round ligament of the uterus. The second part of the paper discusses the incorrect use of the term “lipoma” for retroperitoneal fat, which penetrated into the lumen of the patent processus vaginalis – the authors using this term acknowledge its incorrectness. These lesions often coexist with oblique inguinal hernia and should be excised during a surgery as they may cause inguinal pain. As for other fat-containing inguinal pathologies, we discussed lipomatosis of the spermatic cord, liposarcoma and the greater omentum. Differential diagnosis of these lesions considers their echogenicity, echostructure and vascularity. Furthermore, attention was paid to the adipose tissue surrounding the lower epigastric vessels, which may be incorrectly localized in the inguinal canal. Finally, the importance of proper diagnostic methodology and knowledge of the inguinal anatomy for the correct ultrasonographic diagnosis was emphasized.
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Affiliation(s)
- Andrzej Smereczyński
- Self-Education Ultrasound Study Group, Department of Genetics and Pathomorphology of the Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Katarzyna Kołaczyk
- Self-Education Ultrasound Study Group, Department of Genetics and Pathomorphology of the Pomeranian Medical University in Szczecin, Szczecin, Poland
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17
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Vimercati L, Cavone D, Delfino MC, De Maria L, Caputi A, Ferri GM, Serio G. Asbestos exposure and malignant mesothelioma of the tunica vaginalis testis: a systematic review and the experience of the Apulia (southern Italy) mesothelioma register. Environ Health 2019; 18:78. [PMID: 31470859 PMCID: PMC6717382 DOI: 10.1186/s12940-019-0512-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 08/05/2019] [Indexed: 06/02/2023]
Abstract
BACKGROUND Malignant mesothelioma of the tunica vaginalis testis (MMTVT) is a rare disease with a poor prognosis. The diagnosis and management of these lesions are often difficult for pathologists, surgeons, oncologists and occupational physicians. A preoperative diagnosis of malignancy is rarely made, and there is no established effective therapy except orchidectomy. METHODS A systematic literature review was conducted among the articles published in the English literature on primary MMTVT. Moreover four cases from the Apulia mesothelioma register are reported here. RESULTS Two hundred eighty-nine cases of MMTVT have been reported from 1943 to 2018. Overall asbestos exposure has been investigated only for 58% of all cases reported in this review, while in 41.8% this data are not available. Noteworthy is the fact that in many reports there is not an anamnestic reconstruction of any asbestos exposure. A history of direct occupational, environmental or familial asbestos exposure is found in 27.6% of the cases. The four cases from the Apulia mesothelioma register are all with ascertained occupational exposure to asbestos. CONCLUSIONS The true incidence of asbestos exposure in MMTVT is underestimated because of insufficient information reported in older literature. To establish a broad consensus on the causal relationship between asbestos and MMTVT in the scientific community its necessary to analyze the same variables in the epidemiological studies. In general it should be recommended that a positive history of exposure to asbestos or to asbestos-containing materials are at risk for the development of a MMTVT and should be monitored.
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Affiliation(s)
- Luigi Vimercati
- Interdisciplinary Department of Medicine (DIM), Unit of Occupational Medicine, Section Occupational Medicine. “B. Ramazzini”, University Aldo Moro of Bari Medical School, 11 G. Cesare Square, 70124 Bari, Italy
| | - Domenica Cavone
- Interdisciplinary Department of Medicine (DIM), Unit of Occupational Medicine, Section Occupational Medicine. “B. Ramazzini”, University Aldo Moro of Bari Medical School, 11 G. Cesare Square, 70124 Bari, Italy
| | - Maria Celeste Delfino
- Interdisciplinary Department of Medicine (DIM), Unit of Occupational Medicine, Section Occupational Medicine. “B. Ramazzini”, University Aldo Moro of Bari Medical School, 11 G. Cesare Square, 70124 Bari, Italy
| | - Luigi De Maria
- Interdisciplinary Department of Medicine (DIM), Unit of Occupational Medicine, Section Occupational Medicine. “B. Ramazzini”, University Aldo Moro of Bari Medical School, 11 G. Cesare Square, 70124 Bari, Italy
| | - Antonio Caputi
- Interdisciplinary Department of Medicine (DIM), Unit of Occupational Medicine, Section Occupational Medicine. “B. Ramazzini”, University Aldo Moro of Bari Medical School, 11 G. Cesare Square, 70124 Bari, Italy
| | - Giovanni Maria Ferri
- Interdisciplinary Department of Medicine (DIM), Unit of Occupational Medicine, Section Occupational Medicine. “B. Ramazzini”, University Aldo Moro of Bari Medical School, 11 G. Cesare Square, 70124 Bari, Italy
| | - Gabriella Serio
- Department of Emergency and Organ Transplantation (DETO), Pathology Division, University Aldo Moro of Bari Medical School, 11 G. Cesare Square, 70124 Bari, Italy
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18
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Patoulias I, Rachmani E, Kalogirou M, Chatzopoulos K, Patoulias D. Tunica Vaginalis Thickening, Hemorrhagic Infiltration and Inflammatory Changes in 8 Children with Primary Hydrocele; Reactive Mesothelial Hyperplasia? A Prospective Clinical Study. ACTA MEDICA (HRADEC KRÁLOVÉ) 2018; 61:41-46. [PMID: 30216181 DOI: 10.14712/18059694.2018.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The aim of this study is to describe an entity of primary hydrocele accompanied with fibrosis, thickening and hemorrhagic infiltration of parietal layer of tunica vaginalis (PLTV). During a 4-year period (2011-2014), 94 boys (2.5-14 years old) underwent primary hydrocele repair. Hydrocele was right sided in 55 (58.5 %), left sided in 26 (28.7%) and bilateral in 12 patients (13.8%). Eighty three out of 94 patients (88.30%) had communicating hydrocele and the rest eleven patients (11.7%) had non-communicating. Our case group consists of 8 patients (8.51%) based on operative findings consistent with PLTV induration, thickening and hemorrhagic infiltration. Preoperative ultrasonography did not reveal any pathology of the intrascrotal structures besides hydrocele. There weren't hyperechoic reflections or septa within the fluid. Evaluation of thickness of the PLTV was not feasible. Presence of lymph or exudate was excluded after fluid biochemical analysis. Tunica vaginalis histological examination confirmed thickening, hemorrhagic infiltration and inflammation, while there was absence of mesothelial cells. Immunochemistry for desmin was positive, excluding malignant mesothelioma. One patient underwent high ligation of the patent processus vaginalis and PLTV sheath fenestration, but one year later, he faced a recurrence. An elective second surgery was conducted via scrotal incision and Jaboulay operation was performed. The latter methodology was our treatment choice in other 7 out of 8 patients. During a 2-year postoperative follow-up, no other patient had any recurrence. We conclude that in primary hydrocele with macroscopic features indicative of tunica vaginalis inflammation, reversion of the tunica should be a part of operative strategy instead of sheath fenestration, in order to minimize the recurrence.
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Affiliation(s)
- Ioannis Patoulias
- 1st Department of Pediatric Surgery, Aristotle University of Thessaloniki, General Hospital "G. Gennimatas", Thessaloniki, Greece
| | - Evangelia Rachmani
- 1st Department of Pediatric Surgery, Aristotle University of Thessaloniki, General Hospital "G. Gennimatas", Thessaloniki, Greece
| | - Maria Kalogirou
- 4th Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokration General Hospital, Greece
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19
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Mittal PK, Abdalla AS, Chatterjee A, Baumgarten DA, Harri PA, Patel J, Moreno CC, Gabriel H, Miller FH. Spectrum of Extratesticular and Testicular Pathologic Conditions at Scrotal MR Imaging. Radiographics 2018; 38:806-830. [DOI: 10.1148/rg.2018170150] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Pardeep K. Mittal
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
| | - Ahmed S. Abdalla
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
| | - Argha Chatterjee
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
| | - Deborah A. Baumgarten
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
| | - Peter A. Harri
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
| | - Jay Patel
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
| | - Courtney C. Moreno
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
| | - Helena Gabriel
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
| | - Frank H. Miller
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
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20
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McAdams CR, Del Gaizo AJ. The utility of scrotal ultrasonography in the emergent setting: beyond epididymitis versus torsion. Emerg Radiol 2018; 25:341-348. [PMID: 29679169 DOI: 10.1007/s10140-018-1606-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 04/10/2018] [Indexed: 11/24/2022]
Abstract
Scrotal pain is a common acute presentation for medical care. Testicular torsion and epididymo-orchitis are two diagnoses for which early detection is critical and their sonographic imaging features have been thoroughly described in the radiologic literature. Other important conditions for which radiologists must be aware have received less attention. This article will highlight key traumatic and non-traumatic causes of acute scrotal pain other than testicular torsion and epididymo-orchitis that may present in the emergency department setting.
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Affiliation(s)
- Christopher R McAdams
- Department of Radiologic Sciences, Wake Forest University Baptist Medical Center, Medical Center Blvd, Winston-Salem, NC, 27157, USA.,Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Andrew J Del Gaizo
- Department of Radiologic Sciences, Wake Forest University Baptist Medical Center, Medical Center Blvd, Winston-Salem, NC, 27157, USA.
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21
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Imaging of Acute Conditions of Male Reproductive Organs. Emerg Radiol 2018. [DOI: 10.1007/978-3-319-65397-6_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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22
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Conzi R, Damasio MB, Bertolotto M, Secil M, Ramanathan S, Rocher L, Cuthbert F, Richenberg J, Derchi LE. Sonography of Scrotal Wall Lesions and Correlation With Other Modalities. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:2149-2163. [PMID: 28556191 DOI: 10.1002/jum.14257] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 01/23/2017] [Indexed: 06/07/2023]
Abstract
The scrotal wall may be involved in a variety of pathologic processes. Such lesions may rise primarily from the layers of the scrotum or may be due to a process arising from scrotal content. Imaging is not needed in most cases, but it may be useful for making such differentiations and for evaluation of possible involvement of the testes and epididymides in cases of primary wall abnormalities. This pictorial essay will show the imaging findings observed in a variety of pathologic conditions affecting the scrotal wall, both common and unusual ones, with an emphasis on clinically relevant findings and features that lead to a specific diagnosis.
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Affiliation(s)
- Raffaella Conzi
- Department of Emergency Radiology, Istituto di Ricovero e Cura a Carattere Scientifico, Azienda Ospedaliero-Universitaria, San Martino l'Istituto Scientifico Tumori, Genoa, Italy
| | | | | | - Mustafa Secil
- Department of Radiology, Dokuz Eyul University, Faculty of Medicine, Izmir, Turkey
| | | | | | - Faye Cuthbert
- Department of Radiology, Royal Sussex County Hospital, Brighton, and Brighton and Sussex Medical School, East Sussex, England
| | - Jonathan Richenberg
- Department of Radiology, Royal Sussex County Hospital, Brighton, and Brighton and Sussex Medical School, East Sussex, England
| | - Lorenzo E Derchi
- Department of Emergency Radiology, Istituto di Ricovero e Cura a Carattere Scientifico, Azienda Ospedaliero-Universitaria, San Martino l'Istituto Scientifico Tumori, Genoa, Italy
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23
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Secil M, Bertolotto M, Rocher L, Pekindil G, Stocca T, Richenberg J, Ramchandani P, Derchi LE. Imaging Features of Paratesticular Masses. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1487-1509. [PMID: 28370138 DOI: 10.7863/ultra.16.07015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 09/13/2016] [Indexed: 06/07/2023]
Abstract
In this pictorial essay, we review the sonographic and other imaging findings of paratesticular masses in correlation with the pathologic findings. The examples include benign and malignant tumors and also non-neoplastic mass lesions of the paratesticular structures. Diagnostic sonographic findings of these mass lesions as well as correlative findings of other imaging methods are presented.
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Affiliation(s)
- Mustafa Secil
- Department of Radiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | | | | | - Gokhan Pekindil
- Department of Radiology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Tiziano Stocca
- Department of Radiology, San Giovanni di Dio Hospital, Gorizia, Italy
| | - Jonathan Richenberg
- Royal Sussex County Hospital Brighton and Brighton and Sussex Medical School, Brighton, Sussex, England
| | - Parvati Ramchandani
- Department of Genitourinary Radiology, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, USA
| | - Lorenzo E Derchi
- Department of Radiology, Dipartimento di Scienze Della Salute, University of Genoa, Genoa, Italy
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24
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Mezei G, Chang ET, Mowat FS, Moolgavkar SH. Epidemiology of mesothelioma of the pericardium and tunica vaginalis testis. Ann Epidemiol 2017; 27:348-359.e11. [PMID: 28527639 DOI: 10.1016/j.annepidem.2017.04.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 01/10/2017] [Accepted: 04/06/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE Malignant mesothelioma most commonly arises in the pleura and peritoneum but also occurs rarely at other anatomical sites with mesothelial tissue, namely, the pericardium and tunica vaginalis testis (TVT). This review provides a better understanding of the epidemiology of mesothelioma of these extrapleural sites. METHODS We conducted a systematic review of the epidemiologic and clinical literature on pericardial mesothelioma and mesothelioma of the TVT. We also analyzed U.S. Surveillance, Epidemiology, and End Results cancer registry data to describe incidence patterns of these malignancies. RESULTS An etiologic role of asbestos exposure has been hypothesized for pericardial and TVT mesotheliomas, but no analytical case-control epidemiologic studies exist to test this relationship. A substantial proportion of cases with these malignancies report no known asbestos exposure. In large occupational cohorts with heavy asbestos exposures, no cases of pericardial or TVT mesothelioma have been reported. Trends in the incidence of these malignancies do not match those of pleural mesothelioma, which correspond to historical trends of commercial asbestos use. A male preponderance of pericardial mesothelioma is not evident. CONCLUSIONS In the absence of analytic epidemiologic studies, the etiologic role of environmental risk factors for mesothelioma of the pericardium and TVT remains elusive.
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Affiliation(s)
- Gabor Mezei
- Health Sciences Center, Exponent, Inc., Menlo Park, CA.
| | - Ellen T Chang
- Health Sciences Center, Exponent, Inc., Menlo Park, CA
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Dagur G, Gandhi J, Suh Y, Weissbart S, Sheynkin YR, Smith NL, Joshi G, Khan SA. Classifying Hydroceles of the Pelvis and Groin: An Overview of Etiology, Secondary Complications, Evaluation, and Management. Curr Urol 2017; 10:1-14. [PMID: 28559772 DOI: 10.1159/000447145] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 05/30/2016] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION A hydrocele is defined as the pathological buildup of serous fluid in the pelvis and groin due to various etiologies such as diseases or trauma. It has distinct clinical manifestations, particularly discomfort and psychosocial distress. Understanding the anatomy, embryology, and physiology associated with hydrocele formation is crucial to understand its onset and progression. MATERIALS AND METHODS A MEDLINE® search was conducted using keywords for the relevant classification of hydrocele and its etiology, complications, sexual barriers, evaluation, and management. RESULTS Appropriately classifying the hydrocele as primary, secondary communicating, secondary noncommunicating, microbe-induced, inflammatory, iatrogenic, trauma-induced, tumor-induced, canal of Nuck, congenital, and giant is important for identifying the underlying etiology. Often this process is overlooked when the classification or etiology is too rare. A focused evaluation is important for this, so that timely management can be provided. We comprehensively review the classifications, etiology, and secondary complications of hydrocele. Pitfalls of current diagnostic techniques are explored along with recommended methods for accurate diagnosis and current treatment options. CONCLUSION Due to the range of classifications and etiologies of hydrocele in the pelvis and groin, a deliberate differential diagnosis is essential to avoiding imminent life-threatening complications as well as providing the appropriate treatment.
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Affiliation(s)
- Gautam Dagur
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, N.Y., USA
| | - Jason Gandhi
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, N.Y., USA
| | - Yiji Suh
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, N.Y., USA
| | - Steven Weissbart
- Department of Urology, Stony Brook University School of Medicine, Stony Brook, N.Y., USA.,Women's Pelvic Health & Continence Center, Stony Brook University School of Medicine, Stony Brook, N.Y., USA
| | - Yefim R Sheynkin
- Department of Urology, Stony Brook University School of Medicine, Stony Brook, N.Y., USA
| | | | - Gargi Joshi
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, N.Y., USA
| | - Sardar Ali Khan
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, N.Y., USA.,Department of Urology, Stony Brook University School of Medicine, Stony Brook, N.Y., USA
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Revzin MV, Ersahin D, Israel GM, Kirsch JD, Mathur M, Bokhari J, Scoutt LM. US of the Inguinal Canal: Comprehensive Review of Pathologic Processes with CT and MR Imaging Correlation. Radiographics 2016; 36:2028-2048. [PMID: 27715712 DOI: 10.1148/rg.2016150181] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Ultrasonography (US) has a fundamental role in the initial examination of patients who present with symptoms indicating abnormalities of the inguinal canal (IC), an area known for its complex anatomy. A thorough understanding of the embryologic and imaging characteristics of the contents of the IC is essential for any general radiologist. Moreover, an awareness of the various pathologic conditions that can affect IC structures is crucial to preventing misdiagnoses and ensuring optimal patient care. Early detection of IC abnormalities can reduce the risk of morbidity and mortality and facilitate proper treatment. Abnormalities may be related to increased intra-abdominal pressure, which can result in development of direct inguinal hernias and varicoceles, or to congenital anomalies of the processus vaginalis, which can result in development of indirect hernias and hydroceles. US is also helpful in assessing postoperative complications of hernia repair, such as hematoma, seroma, abscess, and hernia recurrence. In addition, it is often the modality initially used to detect neoplasms arising from or invading the IC. US is an important tool in the examination of patients suspected of having undescended testes or posttraumatic testicular retraction and is essential for the examination of patients suspected of having torsion or infectious inflammatory conditions of the spermatic cord. Online supplemental material is available for this article. ©RSNA, 2016.
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Affiliation(s)
- Margarita V Revzin
- From the Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Devrim Ersahin
- From the Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Gary M Israel
- From the Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Jonathan D Kirsch
- From the Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Mahan Mathur
- From the Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Jamal Bokhari
- From the Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Leslie M Scoutt
- From the Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
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Maronpot RR, Nyska A, Foreman JE, Ramot Y. The legacy of the F344 rat as a cancer bioassay model (a retrospective summary of three common F344 rat neoplasms). Crit Rev Toxicol 2016; 46:641-75. [PMID: 27278595 PMCID: PMC5020328 DOI: 10.1080/10408444.2016.1174669] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The Fischer 344 (F344) rat was used by the National Toxicology Program (NTP) for over 5 decades for toxicity and carcinogenicity studies. However, in 2006, the NTP decided to switch to a different rat stock due largely to high background control incidences of Leydig cell tumors (LCTs) and mononuclear cell leukemia (MNCL), also known as large granular lymphocytic (LGL) leukemia. In the current review, we aim (1) to provide a summary of NTP bioassays with treatment-associated effects involving MNCL and LCTs in addition to male F344-specific tunica vaginalis mesothelioma (TVM); (2) to describe important pathobiological differences between these F344 rat tumor responses and similar target tissue-tumor response in humans; and (3) to present the NTP reasons for switching away from the F344 rat. We show that due to the highly variable background incidence of F344 MNCL, more reliance on historical control data than is usual for most tumor responses is warranted to evaluate potential effect of any chemical treatment in this rat strain. The high spontaneous incidence of LCTs in the testes of male F344 rats has made this tumor endpoint of little practical use in identifying potential testicular carcinogenic responses. TVM responses in F344 rats have a biological plausible relationship to LCTs unlike TVM in humans. Given their high spontaneous background incidence and species-specific biology, we contend that MNCL and LCT, along with TVM responses, in F344 rat carcinogenicity studies are inappropriate tumor types for human health risk assessment and lack relevance in predicting human carcinogenicity.
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Affiliation(s)
| | - Abraham Nyska
- b Sackler School of Medicine, Tel Aviv University, and Consultant in Toxicologic Pathology , Timrat , Israel
| | | | - Yuval Ramot
- d Hadassah-Hebrew University Medical Center , Jerusalem , Israel
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Fenton LZ, Karakas SP, Baskin L, Campbell JB. Sonography of pediatric blunt scrotal trauma: what the pediatric urologist wants to know. Pediatr Radiol 2016; 46:1049-58. [PMID: 27112160 DOI: 10.1007/s00247-016-3600-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 02/02/2016] [Accepted: 02/25/2016] [Indexed: 11/28/2022]
Abstract
Pediatric blunt scrotal trauma is most often the consequence of sports injury and presents a diagnostic challenge because swelling and pain make a scrotal physical exam difficult. US with color flow and duplex Doppler is the first-line imaging modality with the goal of accurate and timely diagnosis of injury requiring surgery to preserve fertility and hormonal function. US imaging findings following blunt scrotal trauma include hydrocele, hematocele, testicular hematoma, testicular fracture, testicular rupture, compromised perfusion/testicular torsion and testicular dislocation. Importantly, several of these findings may coexist. Our goal is to present the pertinent intrascrotal anatomy, US imaging findings for each testicular injury, and contemporary management for each, with emphasis on what our pediatric urology colleagues need to know for optimal patient care.
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Affiliation(s)
- Laura Z Fenton
- Department of Pediatric Radiology, Children's Hospital Colorado, affiliated with the University of Colorado School of Medicine, 13123 East 16th Ave., B125, Aurora, CO, 80045, USA.
| | - S Pinar Karakas
- Department of Radiology, UCSF Benioff Children's Hospital, Oakland, CA, USA
| | - Laurence Baskin
- Department of Pediatric Urology, UCSF Benioff Children's Hospital, San Francisco, CA, USA
| | - Jeffrey B Campbell
- Department of Pediatric Urology, Children's Hospital Colorado, affiliated with the University of Colorado School of Medicine, Aurora, CO, USA
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Kithir Mohamed AS. Foetal inguinoscrotal hernia—its prenatal diagnosis and its spontaneous regression. BJR Case Rep 2016; 2:20150277. [PMID: 30363624 PMCID: PMC6180880 DOI: 10.1259/bjrcr.20150277] [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: 07/10/2015] [Revised: 10/27/2015] [Accepted: 11/17/2015] [Indexed: 11/06/2022] Open
Abstract
A foetal inguinoscrotal hernia is a rare abnormality. We report a case of foetal inguinoscrotal hernia diagnosed by ultrasonography at 37 weeks gestation and its spontaneous regression during the perinatal period. The imaging features, differential diagnosis, pregnancy management and outcome are discussed.
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Rafailidis V, Varelas S, Apostolopoulou F, Rafailidis D. Nonobliteration of the Processus Vaginalis. Sonography of Related Abnormalities in Children. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:805-818. [PMID: 26960801 DOI: 10.7863/ultra.15.04060] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The objective of this pictorial essay is to systematically classify processus vaginalis– related disorders in the light of embryology and present illustrative sonograms with corresponding diagrams. Failure of the processus vaginalis to obliterate during gestation results in a wide spectrum of anomalies, including communicating and noncommunicating hydroceles and inguinal and inguinoscrotal hernias, along with other related disorders of the genital system. There are varying classifications in the literature regarding the aforementioned entities. Proper and timely diagnosis of these entities is essential, given the differences in treatment. Although physical examination can narrow the differential diagnosis, sonography plays an essential role in establishing the diagnosis.
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Aslan A, Tan S, Yıldırım H, Dönmez U, Çam A, Gezer MC, Teber MA, Arslan H. Scrotal calculi in clinical practice and their role in scrotal pain: A prospective study. JOURNAL OF CLINICAL ULTRASOUND : JCU 2015; 43:406-411. [PMID: 25327295 DOI: 10.1002/jcu.22247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 09/02/2014] [Accepted: 09/06/2014] [Indexed: 06/04/2023]
Abstract
PURPOSE Scrotal calculi are rare, and their clinical significance is uncertain. Scrotal pain is a frequent, hard-to-manage problem in urology clinics. Our purpose in this study was to determine the relationship between the presence of scrotal calculi and scrotal pain in a prospective manner. METHODS Sonography and color Doppler ultrasound of the scrotum were performed in 758 consecutive patients referred with scrotal pain. The pain was rated by using an 11-point numeric rating scale; scores were compared among patients with scrotal calculi with and without additional scrotal pathology. RESULTS Scrotal calculi were detected in 73 of the 758 patients (9.6%). Scrotal pain (n = 50 [61%]) and a palpable mass in the scrotum (n = 25 [30.5%]) were the most common complaints in patients with scrotal calculi. Hydrocele (n = 17 [29.8%]) and varicocele (n = 15 [26.3%]) were the most commonly associated abnormalities; there was a statistically significant association between the presence of scrotal calculi and hydrocele (p < 0.01). Scrotal pain was present in 61 (83.5%) patients with scrotal calculi, and this association was significant (p < 0.001). The presence of scrotal pain and the correlation between location of calculi and pain in patients without additional scrotal abnormalities were also significant (p = 0.04 and p < 0.004, respectively). CONCLUSIONS The prevalence of scrotal calculi was 9.6%, and hydrocele was found to be associated with scrotal calculi. We also found a significant relationship between the presence of calculi and scrotal pain. Because the etiology of scrotal pain is essential for appropriate treatment, scrotal calculi should be kept in mind when making a differential diagnosis of scrotal pain. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 43:406-411, 2015.
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Affiliation(s)
- Ahmet Aslan
- Şevket Yılmaz Education and Research Hospital, Department of Radiology, Bursa, Turkey
| | - Sinan Tan
- Şevket Yılmaz Education and Research Hospital, Department of Radiology, Bursa, Turkey
| | - Halil Yıldırım
- Atatürk Education and Research Hospital, Department of Radiology, Ankara, Turkey
| | - Uğur Dönmez
- Atatürk Education and Research Hospital, Department of Radiology, Ankara, Turkey
| | - Ali Çam
- Atatürk Education and Research Hospital, Department of Radiology, Ankara, Turkey
| | - Mehmet Can Gezer
- Atatürk Education and Research Hospital, Department of Radiology, Ankara, Turkey
| | - Mehmet Akif Teber
- Atatürk Education and Research Hospital, Department of Radiology, Ankara, Turkey
| | - Halil Arslan
- Atatürk Education and Research Hospital, Department of Radiology, Ankara, Turkey
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33
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Imaging of mesothelioma of tunica vaginalis testis. Eur Radiol 2015; 26:631-8. [DOI: 10.1007/s00330-015-3887-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 05/15/2015] [Accepted: 06/09/2015] [Indexed: 10/23/2022]
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34
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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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Rafailidis V, Apostolou D, Charsoula A, Rafailidis D. Sonography of the scrotum: from appendages to scrotolithiasis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:507-518. [PMID: 25715371 DOI: 10.7863/ultra.34.3.507] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In this pictorial essay, we review and discuss the varying morphologic characteristics of scrotal appendages and calculi. Characteristic sonograms obtained from patients with coexisting hydrocele are presented, and recent literature is included. Hydrocele greatly facilitates the imaging of these intrascrotal structures, as it acts as a "water path". On the one hand, torsion of a scrotal appendage should always be included in the differential diagnosis of acute scrotum, especially in children. On the other hand, scrotolithiasis may occasionally cause mild discomfort. As a consequence, and given the widespread use of sonography for the evaluation of both acute and chronic conditions of the scrotum, radiologists should be familiar with these entities.
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Affiliation(s)
- Vasileios Rafailidis
- Postgraduate Program in Medical Research Methodology, Aristotle University of Thessaloniki, Thessaloniki, Greece (V.R.); and Department of Radiology, G. Gennimatas General Hospital, Thessaloniki, Greece (D.A., A.C., D.R.).
| | - Dimitrios Apostolou
- Postgraduate Program in Medical Research Methodology, Aristotle University of Thessaloniki, Thessaloniki, Greece (V.R.); and Department of Radiology, G. Gennimatas General Hospital, Thessaloniki, Greece (D.A., A.C., D.R.)
| | - Anna Charsoula
- Postgraduate Program in Medical Research Methodology, Aristotle University of Thessaloniki, Thessaloniki, Greece (V.R.); and Department of Radiology, G. Gennimatas General Hospital, Thessaloniki, Greece (D.A., A.C., D.R.)
| | - Dimitrios Rafailidis
- Postgraduate Program in Medical Research Methodology, Aristotle University of Thessaloniki, Thessaloniki, Greece (V.R.); and Department of Radiology, G. Gennimatas General Hospital, Thessaloniki, Greece (D.A., A.C., D.R.)
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D M, M KT, Khan DM. Encysted Spermatic Cord Hydrocele in a 60-year-old, Mimicking Incarcerated Inguinal Hernia: A Case Report. J Clin Diagn Res 2014; 8:153-4. [PMID: 24701514 DOI: 10.7860/jcdr/2014/6998.4039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 12/20/2013] [Indexed: 11/24/2022]
Abstract
Hydrocele of spermatic cord is caused by defect in closure of the processus vaginalis, as the testicles descend into the scrotum during foetal development. It usually occurs in infancy and childhood. There are two types of hydrocele of spermatic cord. Encysted type is caused by defective closure at both proximal and distal ends of processus vaginalis and it does not communicate with the peritoneal cavity. Funicular type is caused by defective closure of only distal end of tunica vaginalis and it communicates with the peritoneal cavity. The encysted type can be confused clinically with incarcerated inguinal hernia, inguinal lymphadenopathy, undescended testis and primary tumours of cord like lipoma. We are presenting a case of encysted hydrocele of spermatic cord in a 60-year-old male, which clinically mimicked incarcerated inguinal hernia.
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Affiliation(s)
- Manimaran D
- Associate Professor, Department of Pathology, Shri Sathya Sai Medical College and Research Institute , Tiruporur, Tamilnadu, India
| | - Karthikeyan T M
- Associate Professor, Department of Pathology, Melmaruvathur Adhiparasakthi Institute of Medical Science and Research , Melmaruvathur, Tamilnadu, India
| | - Dost Mohamed Khan
- Associate Professor, Department of Pathology, Shri Sathya Sai Medical College and Research Institute , Tiruporur, Tamilnadu, India
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Prapruttam D, Hedgire SS, Mani SE, Chandramohan A, Shyamkumar NK, Harisinghani M. Tuberculosis--the great mimicker. Semin Ultrasound CT MR 2014; 35:195-214. [PMID: 24929261 DOI: 10.1053/j.sult.2014.02.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Tuberculosis is an immense health problem in the developing world, and it remains a health care challenge in the developed world. It can affect virtually any organ system in the body. Diagnosis of tuberculosis is often difficult. Many patients with tuberculosis present with nonspecific symptoms, negative purified protein derivative skin test result, and negative findings on culture specimens. Cross-sectional imaging with ultrasound, multidetector computed tomography, and magnetic resonance imaging plays an important role in the diagnosis of tuberculosis. Tuberculosis demonstrates a variety of radiologic features depending on the organ involved and can mimic a number of other disease entities. Cross-sectional imaging alone is insufficient in reaching a conclusive diagnosis. Tuberculosis is a great mimicker as its radiologic manifestations can simulate numerous other diseases across the body systems. However, recognition and understanding of the common and uncommon radiologic manifestations of tuberculosis should alert considering tuberculosis in the high-risk population and correct clinical setting to enable appropriate treatment.
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Affiliation(s)
- Duangkamon Prapruttam
- Division of Abdominal Imaging and Intervention, Massachusetts General Hospital-Harvard Medical School, Boston, MA
| | - Sandeep S Hedgire
- Division of Abdominal Imaging and Intervention, Massachusetts General Hospital-Harvard Medical School, Boston, MA.
| | - Sunithi Elizabeth Mani
- Department of Radiology, Christian Medical College, Thottapalayam, Vellore, Tamil Nadu, India
| | - Anuradha Chandramohan
- Department of Radiology, Christian Medical College, Thottapalayam, Vellore, Tamil Nadu, India
| | - N K Shyamkumar
- Department of Radiology, Christian Medical College, Thottapalayam, Vellore, Tamil Nadu, India
| | - Mukesh Harisinghani
- Division of Abdominal Imaging and Intervention, Massachusetts General Hospital-Harvard Medical School, Boston, MA
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Quiligotti C, Merico V, Bortolotto C. Role of color-Doppler US in the evaluation of scrotal edema. J Ultrasound 2013; 16:227-9. [DOI: 10.1007/s40477-013-0039-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 09/23/2013] [Indexed: 11/25/2022] Open
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Torsion of a benign cyst of the tunica vaginalis presenting as an acute scrotum: A case report and literature review. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2013. [DOI: 10.1016/j.epsc.2013.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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41
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Arend CF. Static and dynamic sonography for diagnosis of abdominal wall hernias. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:1251-1259. [PMID: 23804348 DOI: 10.7863/ultra.32.7.1251] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Sonography is a fast, painless, inexpensive, and widely available tool usually regarded as a first-line imaging modality for abdominal wall evaluation. This article provides illustrative images and videos on the use of sonography for diagnosis of abdominal wall hernias. A variety of pitfalls that may present clinically as pseudohernias are also described.
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Affiliation(s)
- Carlos Frederico Arend
- Radimagem Diagnostico por Imagem, Cristóvão Colombo 1691, 90560-004 Porto Alegre-RS, Brazil.
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42
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Imaging of Acute Conditions of Male Reproductive Organs. Emerg Radiol 2013. [DOI: 10.1007/978-1-4419-9592-6_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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43
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Hebert SC, Chong WK, Deurdulian C. Essentials of scrotal ultrasound: A review of frequently encountered abnormalities. APPLIED RADIOLOGY 2012. [DOI: 10.37549/ar1932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Serefoglu EC, Mandava SH, Sikka SC, Hellstrom WJG. PENILE DOPPLER SONOGRAPHIC AND CLINICAL CHARACTERISTICS IN PEYRONIE'S DISEASE AND/OR ERECTILE DYSFUNCTION: AN ANALYSIS OF 1500 MEN WITH SEXUAL DYSFUNCTION. BJU Int 2012; 110:E154-5; author reply E155-6. [DOI: 10.1111/j.1464-410x.2012.10674_3.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Yang DM, Kim HC, Lim SJ. Sonographic findings of fibrous pseudotumor of the tunica vaginalis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2012; 40:252-254. [PMID: 22031022 DOI: 10.1002/jcu.20888] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Accepted: 08/26/2011] [Indexed: 05/31/2023]
Abstract
We report the sonographic findings in a case of fibrous pseudotumor of the tunica vaginalis. Scrotal gray-scale sonography revealed a well-margined, hypoechoic mass with an onion ring appearance and central calcifications in the left scrotum. Color Doppler sonography showed no blood flow within the mass. The pathological examination revealed a fibrous pseudotumor with a paucicellular and fibroblastic proliferation of cells within a hyalinized collagenous stroma.
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Affiliation(s)
- Dal Mo Yang
- Department of Radiology and Pathology, Kyung Hee University Hospital at Gangdong, 149 Sangil-Dong, Gangdong-Gu, Seoul, South Korea
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Valentino M, Bertolotto M, Ruggirello M, Pavlica P, Barozzi L, Rossi C. Cystic lesions and scrotal fluid collections in adults: Ultrasound findings. J Ultrasound 2011; 14:208-15. [PMID: 23396379 DOI: 10.1016/j.jus.2011.10.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The widespread use of scrotal ultrasonography (US) has led to increased detection of testicular and extratesticular pathologies. Cystic or encapsulated fluid collections are relatively common benign lesions that usually present as palpable testicular lumps. Most cysts arise in the epidydimis, but all anatomical structures of the scrotum can be the site of their origin. US may suggest a specific diagnosis for a wide variety of intrascrotal cystic and fluid lesions and appropriately guide therapeutic options. US should be used as an adjunctive diagnostic modality after clinical evaluation of a scrotal lesion associated or not with the presence of a lump.
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Affiliation(s)
- M Valentino
- Urgency and Emergency Radiology, Department of Radiology and Diagnostic Imaging, Hospital of Parma, Italy
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WITHDRAWN: Lymphoma of the scrotum in patients with Down’s syndrome: US appearance. Mini pictorial essay. J Ultrasound 2011. [DOI: 10.1016/j.jus.2011.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Mand S, Debrah AY, Klarmann U, Mante S, Kwarteng A, Batsa L, Marfo-Debrekyei Y, Adjei O, Hoerauf A. The role of ultrasonography in the differentiation of the various types of filaricele due to bancroftian filariasis. Acta Trop 2011; 120 Suppl 1:S23-32. [PMID: 20673752 DOI: 10.1016/j.actatropica.2010.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Revised: 05/04/2010] [Accepted: 07/02/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE (i) To determine the frequencies of urogenital pathologies in men infected with bancroftian filariasis, and (ii) to evaluate the role of ultrasonography (USG) as a diagnostic tool to differentiate between diverse pathologies with different clinical implications. To date, all types of scrotal enlargement resulting from lymphatic filariasis (LF) have been summarized under one term: "filaricele". PATIENTS AND METHODS Data were compiled from recruitment phases for field trials in an endemic area for LF in Ghana. 1453 men aged 18 years and above underwent ultrasound examinations of the scrotum. Observation parameters were: Filaria Dance Sign (FDS), dilation of supratesticular lymphatic vessels, thickness of scrotal skin, occurrence and amount of fluid accumulation, echogenicity of the fluid between the layers of the tunica vaginalis, as well as position and homogenicity of testis, epididymis and spermatic cord. In 1132 men, blood samples were taken for parasitological analysis. RESULTS In 56% of examined patients, fluid accumulation around the testis was detected (38% subclinical-, 18% clinical stages). Differentiation of the echogenicity of the fluid revealed echo-free hydrocele (EFH) in 47% and echo-dense hydrocele (EDH) in 9%. Patients without hydrocele and subclinical stages had a thinner scrotal skin than those in clinical stages or with lymphscrotum (P < 0.001). In the EDH group the scrotal skin was thicker than in the EFH group (P < 0.001). 1.4% had a lymphscrotum. FDS was detected in 24% of all 1453 volunteers who underwent USG. The number of worm nests correlated with microfilarial load and levels of circulating filarial antigen (P < 0.001; 20% microfilaremic, 48% antigen positive). CONCLUSION In an unexpected high number of men (56%) fluid accumulation around the testis was detected by USG of which more than one third (38%) presented with subclinical stages. The study showed that echo-dense and echo-free fluid could be differentiated and that a considerable number of cases had EDH (9%) posing a risk to develop necrotic testis and infertility and therefore requiring immediate surgical intervention. USG thus turned out to be a useful diagnostic technique to differentiate between those cases requiring immediate surgical intervention from those that can be treated with (anti-wolbachial and hyperpermeability reducing) drugs that ameliorate or halt progression of the disease.
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Lymphoma of the scrotum in patients with Down's syndrome: US appearance. Mini-pictorial essay. J Ultrasound 2011; 14:216-9. [PMID: 23397043 DOI: 10.1016/j.jus.2011.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Down's syndrome is relatively common, and patients who are affected have an increased risk of developing acute leukemia, but not solid tumors. Studies performed in larger patient populations have shown that solid tumors, including lymphomas, are significantly less frequent in Down patients than in children and adults who are not Trisomy 21-affected.Testicular lymphomas are rare and extremely aggressive. Ultrasound (US) combined with color Doppler is essential in the diagnosis and evaluation of treatment results in these lesions. As they are very rare, it was decided to publish this mini-pictorial essay.
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