Clinically Symptomatic Vasitis: Clinical Correlations in a Rare Condition

A Rare Case of Acute Vasitis

Inflammation of the vas deferens, or vasitis, is a rarely reported condition that can manifest as either acutely painful infectious vasitis or predominantly asymptomatic vasitis nodosa. Acute vasitis is usually presented with ambiguous clinical findings, and a scan is required for a definitive diagnosis. Retrograde urinary pathogens are typically the cause, and it is treatable conservatively. We present a male in his 40s with a one-day history of right groin pain and a history of right indirect inguinal hernia. On examination, there was an impression of an incarcerated inguinal hernia. A CT scan revealed thickening and inflammatory changes associated with the inguinal canal and a picture of the rare inflammatory condition, acute vasitis. This case report illustrates the significance of understanding the wide range of possible diagnoses associated with acute groin pain and swelling and the importance of imaging in the diagnosis, which might help avoid needless operation.

A pictorial review of genitourinary infections and inflammations

Various infectious and inflammatory diseases affect the genitourinary system. This paper provides a review of multiple common and uncommon infectious and inflammatory conditions affecting the genitourinary system and some associated complications. These include acute infectious cystitis, emphysematous cystitis, acute pyelonephritis, emphysematous pyelonephritis, renal and perinephric abscesses, pyonephrosis, xanthogranulomatous pyelonephritis, epididymo-orchitis, vasitis, prostatitis, pelvic inflammatory disease, renal hydatid infection, renal tuberculosis, actinomycosis, Erdheim-Chester Disease, IgG4-Related Kidney Disease, urethritis and urethral strictures, ureteritis cystica, and genitourinary fistulas. Radiologists should be aware of these diseases' complications and management. Uncommon conditions must be considered when evaluating the genitourinary system.

Misdiagnosis of vasitis: a potential diagnostic pitfall with computed tomography

Background

Vasitis is a rare condition that may be challenging for the clinical practitioner. Sometimes it is misdiagnosed as incarcerated inguinal hernia; thus, patients end up receiving unnecessary surgery. Compared with the traditional approach with only sonography, the more recent introduction of computed tomography in the diagnostic process has provided higher quality imaging and more detailed anatomy. Consequently, some urologists advocate the efficacy of computed tomography in the differential diagnosis of difficult cases.

Case presentation

We present the case of a 23-year-old male who suffered from right inguinal pain and swelling. His scrotum ultrasound showed multiple tubular structure dilatation within the subinguinal area and no testis torsion. The initial diagnosis was a right inguinal hernia. Computed tomography supported that initial diagnosis, and we presumed the lesion represented a herniation of the omentum with mesenteric vessels. Since there was a suspicion of hernia incarceration, the patient underwent diagnostic laparoscopy, which did not reveal herniation, but only erythematous reaction and swelling over the right spermatic cord. Following a final diagnosis of vasitis, he received empirical antibiotic treatment and his symptoms entirely resolved.

Conclusions

Even though computed tomography can provide thorough imaging of the urogenital system, the contrast enhancement within vessels and inflammatory organs can still be misleading in the diagnostic process.

Ultrasound of the Normal and Abnormal Vas Deferens

ABSTRACT

The extrapelvic portion of the vas deferens is readily visible with ultrasound but often overlooked. Several publications have described the scanning technique and the normal anatomy of the vas deferens. Sonographic evaluation of the vas deferens provides critical information in the workup of male infertility. Obstruction, inflammatory conditions, and neoplasms of the vas deferens can also be diagnosed with ultrasound. Knowledge of the normal and abnormal appearance of the vas deferens improves scans of the scrotum and expands the conditions that can be recognized and accurately diagnosed with ultrasound.

Vasitis mimicking an inguinal hernia: A diagnostic dilemma

Vasitis is a rare disorder characterised by inflammation of the vas deferens. It presents with scrotal or inguinal pain/swelling, mimicking the more commonly occurring conditions such as epididymitis, orchitis, testicular torsion or an incarcerated inguinal hernia. While ultrasound may exclude some of these differential diagnoses, computed tomography (CT) or Magnetic resonance imaging (MRI) is needed to distinguish vasitis from an incarcerated inguinal hernia. Vasitis is classically treated with antibiotics so proper diagnosis is essential to avoid unnecessary surgery. We present the case of a 20-year-old male with CT diagnosed vasitis, whose condition resolved within six weeks without administering antibiotics.

Pelvic lipomatosis presenting with chronic vasitis: a case report

Background

Vasitis is a rare condition and has not been reported in the literature in association with pelvic lipomatosis.

Case presentation

25-year-old young male presented with bilateral scrotal pain. He was found to have bilateral thickened and tender vas. On further evaluation, he was diagnosed with pelvic lipomatosis and dilated vas up to ejaculatory duct. He was treated with anti-inflammatory medication and is on close follow-up to look for further symptoms related to other luminal compressive pathologies that are known to occur with pelvic lipomatosis.

Conclusion

In patients with pelvic lipomatosis, careful examination of genitalia is necessary to look for other compressive findings including vasal obstruction and vasitis.

Vasitis: a rare diagnosis mimicking inguinal hernia: a case report

BACKGROUND

Vasitis or inflammation of the vas deferens is a rare condition, and few case reports with computed tomography images have been published since 1980.

CASE PRESENTATION

A 50-year-old man presented with severe right inguinal and lower abdominal pain. Initial diagnosis at the emergency department was incarcerated or strangulated inguinal hernia. The computed tomography scan revealed diffuse edematous changes of right spermatic cord and vas deferens with peripheral fat stranding. Correlating with his clinical symptoms, signs, and imaging findings, the diagnosis of vasitis was made. We report a case of acute vasitis about the cause, symptom, pathogen, differential diagnoses, image findings, and treatment.

CONCLUSION

Although very rare, vasitis should be listed as one of the differential diagnosis for inguinal mass lesions. Cross-sectional imaging may be necessary to confirm the diagnosis and exclude differentials such as an inguinal hernia. Recognition of the characteristic image findings can help to make the correct diagnosis and avoid unnecessary surgery.

Pediatric vasitis: A rare complication of epididymitis

Vasitis represents an inflammation of the vas deferens. This is a rare entity seen mostly in adult males following local surgery (e.g., vasectomy, hernia repair). Children with groin masses have a wide differential diagnosis. We describe a child with a groin mass following epididymitis diagnosed with vasitis and review the known literature regarding diagnostic tools and treatment. Vasitis in children, although rare, can be seen as a complication of epididymitis.