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Siraj QH. Functional Imaging of Testicular Torsion. Semin Nucl Med 2023; 53:797-808. [PMID: 37210316 DOI: 10.1053/j.semnuclmed.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 04/20/2023] [Accepted: 04/22/2023] [Indexed: 05/22/2023]
Abstract
This article discusses the current clinical role and scope of functional radionuclide imaging using testicular perfusion scintigraphy with 99mTc-pertechnetate in patients presenting with an acute hemiscrotum for an early and reliable diagnosis of testicular torsion. The technique of testicular perfusion scintigraphy is described, and the characteristic findings are detailed with examples. The imaging characteristics of the various phases of testicular torsion and its differentiation from epididymitis and/or epididymo-orchitis and the other related conditions presenting as an acute hemiscrotum are detailed. In some cases, further evaluation by SPECT imaging increases the clarity and accuracy of diagnosis and, on occasion, hybrid SPECT/CT in selected complicated cases improves the diagnostic yield of the perfusion scintigraphy. Ultrasonographic and color Doppler findings are described concurrently with the scintigraphic findings. The several case examples presented demonstrate the additional clinical benefit of complementing functional and structural imaging for improving the sensitivity, specificity and accuracy of testicular imaging in the diagnosis.
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Affiliation(s)
- Qaisar H Siraj
- Department of Nuclear Medicine, Farwaniya Hospital Kuwait, Kuwait City, Kuwait.
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2
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Aydin S, Tokur O, Kazci O, Ece B, Karavas E, Kantarci M. Sonographic findings of COVID-19 related acute scrotal infection and associations with clinical-laboratory data. J Clin Ultrasound 2022; 50:1385-1390. [PMID: 35775362 PMCID: PMC9349983 DOI: 10.1002/jcu.23263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/15/2022] [Accepted: 06/16/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND During the Coronavirus Disease 2019 (COVID-19) pandemic, patients present to hospitals with a wide range of symptoms. Some of these symptoms include acute orchitis and epididymitis. The goal of this research is to see if COVID-19 infection and scrotal infection are associated. MATERIALS AND METHODS Patients with a COVID-19 (+) who agreed to a scrotal ultrasound (US) examination were studied prospectively in a tertiary care center between October 2021 and February 2022. The severity of the disease was used to divide patients into groups. Patients diagnosed with acute scrotal infection based on scrotal ultrasonography findings were compared in these groups, as were their age, comorbidities, and laboratory data. RESULTS The median age of the 213 participants was 61.7 ± 8.3. During the ultrasonographic examination of the patients, 15 (7%), 8 (3.7%), 17 (7.9%), and 40 (18.7%) were diagnosed with acute orchitis, acute epididymitis, acute epididymo-orchitis, and scrotal infection, respectively. Acute scrotal infection was far more common in patients with a higher clinical severity of the disease. The patients' comorbidities were also assessed, and it was discovered that they were statistically more common in the same group. CONCLUSIONS Even if there are no clinical symptoms, ultrasonography can help detect acute scrotal infection in COVID-19 patients. Furthermore, in groups with higher clinical severity, this association is more likely to be seen. It is critical to understand this in order to avoid complications.
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Affiliation(s)
- Sonay Aydin
- Department of RadiologyErzincan UniversityErzincanTurkey
| | - Oğuzhan Tokur
- Department of RadiologyAnkara Training and Research HospitalAnkaraTurkey
| | - Omer Kazci
- Department of RadiologyYuksek Ihtisas UniversityAnkaraTurkey
| | - Bunyamin Ece
- Department of RadiologyKastamonu UniversityKastamonuTurkey
| | - Erdal Karavas
- Department of RadiologyErzincan UniversityErzincanTurkey
| | - Mecit Kantarci
- Department of RadiologyErzincan UniversityErzincanTurkey
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Aeschimann E, Sanchez O, Birraux J, Wildhaber BE, Manzano S. How useful is a complete urinary tract ultrasound in orchiepididymitis? PLoS One 2022; 17:e0263934. [PMID: 35143594 PMCID: PMC8830649 DOI: 10.1371/journal.pone.0263934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 01/30/2022] [Indexed: 12/04/2022] Open
Abstract
Orchiepididymitis (OE) is a frequent cause of pediatric emergency department attendance in boys presenting with acute scrotum. The etiology of most episodes of OE remains unclear and there is no consensus regarding the correlation between OE and underlying genitourinary malformations. Whether imaging evaluation should comprise complete urinary tract ultrasonography (US) or voiding cystography is a subject of debate. The aim of this retrospective, single-center study was to analyze i) the number/type of urinary tract malformations detected by US following a first episode of OE in boys with no previously known malformation and ii) the frequency of associated urinary tract infection (UTI). We reviewed the records of 495 boys <16 years presenting to our pediatric emergency department with acute scrotum between January 2012 and December 2017. Patients with incomplete radiological data were excluded. Of 119 boys with a radiologically-confirmed first episode of OE, 99 had a complete urinary tract US and were included in the study. No genitourinary malformation was detected (0%). Urinary cultures showed UTI in 3/98 (3.1%) patients. Mean age at presentation was 9.7 years (standard deviation, 3.9) with a three-peak incidence of OE at 10–13 years, 4–5 years, and during infancy. Conclusion: Complete urinary tract US does not appear to be useful during a first episode of OE in countries with an antenatal US screening rate similar to Switzerland. The very low UTI rate suggests that a urinalysis is sufficient to investigate a first episode of OE and antibiotics should be reserved for positive urinalysis only.
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Affiliation(s)
- Eva Aeschimann
- Pediatric Emergency Division, Department of Pediatrics, Gynecology, and Obstetrics, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
- * E-mail:
| | - Oliver Sanchez
- Division of Child’s and Adolescent’s Surgery, Department of Pediatrics, Gynecology, and Obstetrics, University Center of Pediatric Surgery of Western Switzerland, Lausanne, Switzerland
| | - Jacques Birraux
- Division of Child’s and Adolescent’s Surgery, Department of Pediatrics, Gynecology, and Obstetrics, University Center of Pediatric Surgery of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Barbara E. Wildhaber
- Division of Child’s and Adolescent’s Surgery, Department of Pediatrics, Gynecology, and Obstetrics, University Center of Pediatric Surgery of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Sergio Manzano
- Pediatric Emergency Division, Department of Pediatrics, Gynecology, and Obstetrics, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
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Hassell J, Kitteringham L, Hall NJ. The role of ultrasound in detecting renal tract abnormalities following a single episode of epididymitis. J Pediatr Surg 2022; 57:275-277. [PMID: 34823844 DOI: 10.1016/j.jpedsurg.2021.10.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 10/23/2021] [Indexed: 11/17/2022]
Abstract
AIM The aim of the study was to establish the utility of ultrasound scan in detecting renal tract abnormalities following a single episode of epididymitis. METHODS A single-centre retrospective review of all boys diagnosed with epididymitis between October 2012 and 2017 including review of follow up imaging and clinical course was completed. Primary outcome was new diagnosis of renal tract abnormality by ultrasound. MAIN RESULTS Eighty-four boys with a first diagnosis of epididymitis were identified. Sixty-four cases (76%) were diagnosed at scrotal exploration, the remaining twenty clinically. Median age was 7.30 years (range 0.08-15.83 years), and five had a positive urine culture at presentation. Forty-eight boys (57%) had a follow-up ultrasound scan (at median 4.57 weeks [range 1-31 weeks]). Only two renal tract abnormalities were identified by ultrasound scan, both in boys aged < 6 months, and neither was clinically relevant. Recurrent epididymitis occurred in 4 cases at median 26 days after initial presentation, of whom 3 had been followed up by ultrasound after initial presentation, all of which were normal. Further investigation revealed posterior urethral valves in 1 boy (age 6.5 months at initial presentation). CONCLUSION Following a single episode of epididymitis, ultrasound was not helpful at detecting clinically relevant renal tract abnormalities, and furthermore did not identify the only patient with a clinically relevant abnormality. Based on these data, we propose follow-up imaging only in boys ≤ 6 months of age with a positive urine culture or a recurrent episode with consideration given to micturating cystogram even if ultrasound normal. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jack Hassell
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK
| | - Lara Kitteringham
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK
| | - Nigel J Hall
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK; University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, UK.
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Huang DY, Pesapane F, Rafailidis V, Deganello A, Sellars ME, Sidhu PS. The role of multiparametric ultrasound in the diagnosis of paediatric scrotal pathology. Br J Radiol 2020; 93:20200063. [PMID: 32271626 PMCID: PMC10993215 DOI: 10.1259/bjr.20200063] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 02/06/2023] Open
Abstract
Multiparametric ultrasound (MPUS), combining conventional techniques (greyscale and colour Doppler ultrasound), ultrasound strain elastography, and contrast-enhanced ultrasound (CEUS), has been successfully used in the assessment of adult scrotal pathology. Contrast-enhanced ultrasound can confidently establish testicular tissue vascularity even in the small-volume paediatric testis. Elastography provides further assessment of tissue stiffness, potentially adding useful diagnostic information. In children, ultrasonography is particularly advantageous, being safe, radiation-free and negating the need for sedation or general anaesthesia during the imaging evaluation. In this review article, we aim to familiarise readers with the MPUS scanning protocol used for paediatric scrotal examination and provide an overview of scrotal MPUS features, with particular focus to clinical indications where MPUS may be advantageous over conventional ultrasonography.
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Affiliation(s)
- Dean Y. Huang
- Department of Radiology, King’s College Hospital,
London. Denmark Hill, London SE5 9RS
U.K, United Kingdom
| | - Filippo Pesapane
- Breast Imaging Division, IEO European Institute of Oncology
IRCCS, Via Giuseppe Ripamonti 435, 20141,
Milan, Italy
| | - Vasileios Rafailidis
- Department of Radiology, King’s College Hospital,
London. Denmark Hill, London SE5 9RS
U.K, United Kingdom
| | - Annamaria Deganello
- Department of Radiology, King’s College Hospital,
London. Denmark Hill, London SE5 9RS
U.K, United Kingdom
| | - Maria E. Sellars
- Department of Radiology, King’s College Hospital,
London. Denmark Hill, London SE5 9RS
U.K, United Kingdom
| | - Paul S Sidhu
- Department of Radiology, King’s College Hospital,
London. Denmark Hill, London SE5 9RS
U.K, United Kingdom
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Xu L, Li CQ, Qiu MJ, Yang Y. [Scrotoscopy in the diagnosis and treatment of testicular and epididymal diseases: Analysis of 39 cases]. Zhonghua Nan Ke Xue 2020; 26:134-138. [PMID: 33346416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To investigate the efficiency, safety and clinical application value of scrotoscopy in the diagnosis and treatment of testicular and epididymal diseases. METHODS A total of 39 patients with testicular or epididymal diseases underwent scrotoscopic surgery in our hospital from February 2015 to February 2018. We retrospectively analyzed the clinical data, results of surgery, and postoperative scrotal pain scores, complications and recurrence. RESULTS Scrotoscopic surgery was successfully performed in all the 39 cases, without such severe complications as testis rupture and scrotal hematoma. Thirteen cases of epididymal tumor were treated by total excision of the tumors by laser ablation; 10 of the 12 patients complaining of chronic testicular pain were diagnosed with incomplete torsion of testicular or epididymal appendages and treated by holmium laser ablation; of the 11 cases of suspected testicular torsion, 8 were confirmed as testicular torsion and the other 3 as acute epididymitis; and 3 cases of scrotal trauma-induced old hematoma underwent surgical removal under the scrotoscope. No infection of scrotal incision occurred postoperatively. The visual analog pain scores of the patients averaged 3.4 ± 1.2 (2-5) and their hospital stay 3.2 ± 0.8 (3-6) days. Scrotal ultrasonography at 1 month after surgery revealed no abnormality in the testis, epididymis or spermatic cord. CONCLUSIONS Scrotoscopy is safe and effective for the diagnosis and treatment of testicular and epididymal diseases and deserves a wide clinical application.
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Affiliation(s)
- Le Xu
- Department of Urology, He Xian Memorial Hospital Affiliated to Southern Medical University, Guangzhou, Guangdong 511400, China
| | - Can-Qiang Li
- Department of Urology, He Xian Memorial Hospital Affiliated to Southern Medical University, Guangzhou, Guangdong 511400, China
| | - Min-Jie Qiu
- Department of Urology, He Xian Memorial Hospital Affiliated to Southern Medical University, Guangzhou, Guangdong 511400, China
| | - Yi Yang
- Department of Urology, He Xian Memorial Hospital Affiliated to Southern Medical University, Guangzhou, Guangdong 511400, China
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Abstract
AIM In brucellosis the male genitourinary system can be affected in a small number of patients. In this study we aimed to identify, discuss and compare the radiologic findings of 24 cases with Brucella epididymo-orchitis (BEO) and 285 cases with non-Brucella epididymis orchitis (NBEO). MATERIAL AND METHODS The study had a retrospective design. The area of involvement, side of involvement (left, right or bilateral), presence of abscess, hydrocele and testicular involvement pattern were analyzed and compared between the BEO and NBEO cases. RESULTS The median age of the included cases was 33 years, with a minimum of 0 and maximum of 89. Epididymo-orchitis and isolated orchitis were more frequent in BEO cases while isolated epididymis involvement was more common in patients with non-BEO (p=0.0117). Bilateral involvement was present in 20.8% and 4.6% cases in the BEO and non-BEO groups, respectively (p=0.008). The frequency of abscess was significantly higher in BEO cases (p=0.003). CONCLUSION Although the radiological indications of BEO are similar to those of other types of epididymo-orchitis, abscess formation, bilateral involvement and testicular involvement contribute significantly to diagnosis.
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Affiliation(s)
| | - Hakan Sezgin Sayiner
- Adiyaman University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Ibrahim Inan
- Radiology Department, BiruniUniversity Hospital, Istanbul, Turkey.
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Shao GF, Ma TJ, Liu YQ, Li JJ, Wang WZ, Yuan MZ. [Real-time transrectal ultrasonography in seminal vesiculoscopy]. Zhonghua Nan Ke Xue 2017; 23:337-342. [PMID: 29714419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To compare three different pathways for transurethral seminal vesiculoscopy (SVS) and investigate the reliability and efficiency of transrectal ultrasonography (TRUS)-guided SVS (TRUS-SVS). METHODS We retrospectively analyzed 90 cases of seminal vesiculoscopy conducted directly through the ejaculatory duct or prostatic utricle or under the guide of TRUS. We compared the success rate and complications among the three approaches. RESULTS Operations were successfully performed in 87 (96.67%) of the 90 cases, 30 through the ejaculatory duct, 37 via the prostatic utricle, and 20 under the guide of TRUS, the operation time ranging from 25 to 75 minutes. Sperm was detected from the seminal vesicle fluid in (92.06%) of the azoospermia patients (58/63) during the surgery and in 77.78% of them (49/63) in semen analysis at 1 week postoperatively. Fifteen hematospermia and 12 spermatocystitis patients were cured. Postoperative follow-up found 20 cases of water-like semen and 3 cases of orchiepididymitis, but no such complications as retrograde ejaculation, incontinence, or rectourethral fistula. CONCLUSIONS Transejaculatory duct and transprostatic utricle pathways are two common approaches to SVS, while TRUS-SVS may achieve a higher success rate and avoid injury of both the prostate and the rectum.
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Affiliation(s)
- Guang-Feng Shao
- Department of Urology, The Second Hospital of Shandong University, Jinan, Shandong 250033, China
| | - Tian-Jia Ma
- Department of Urology, The Second Hospital of Shandong University, Jinan, Shandong 250033, China
| | - Yu-Qiang Liu
- Department of Urology, The Second Hospital of Shandong University, Jinan, Shandong 250033, China
| | - Jun-Jia Li
- Department of Urology, The Second Hospital of Shandong University, Jinan, Shandong 250033, China
| | - Wen-Zhen Wang
- Department of Urology, The Second Hospital of Shandong University, Jinan, Shandong 250033, China
| | - Ming-Zhen Yuan
- Department of Urology, The Second Hospital of Shandong University, Jinan, Shandong 250033, China
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Cheng FY, Su YJ. Septic Pulmonary Emboli Associated with Klebsiella Pneumoniae Epididymitis. J Emerg Med 2016; 50:e23-4. [PMID: 26443643 DOI: 10.1016/j.jemermed.2015.03.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 03/01/2015] [Accepted: 03/24/2015] [Indexed: 02/07/2023]
Affiliation(s)
- Fei-Ying Cheng
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Yu-Jang Su
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan; Department of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan; Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
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Abstract
OBJECTIVES To evaluate characteristic sonographic findings for mumps orchitis with epididymal involvement. METHODS This study included 18 patients (aged 12-18 years) with mumps orchitis. We assessed the volume, echogenicity, and vascularity of the testes and the transverse diameter, echogenicity, and vascularity of the epididymal head, body, and tail. We classified 4 types of epididymal involvement: 1A, focal swelling of the epididymal head with hypervascularity only on the swollen head; 1B, focal swelling of the epididymal head with hypervascularity on the entire epididymis; 1C, diffuse swelling of the entire epididymis with hypervascularity; and 2, no epididymal involvement. The Student t test was used to evaluate the significance of the size of each part of the epididymis and the epididymal head-to-tail diameter ratio. RESULTS Orchitis was unilateral in 13 patients and bilateral in 5. Of 23 affected hemiscrotums, 7 (30.4%) were type 1A, 4 (17.4%) type 1B, 2 (8.7%) type 1C, and 10 (43.5%) type 2. In 11 patients with unilateral epididymal involvement, the mean diameters ± SDs of the epididymal heads on the affected and contralateral sides were 1.11 ± 0.19 (range, 0.7-1.7) and 0.65 ± 0.14 (0.3-0.9) cm (significantly different, P <.001). The diameters of the epididymal tails on the affected and contralateral sides were 0.51 ± 0.41 (0.2-0.8) and 0.46 ± 0.21 (0.3-0.6) cm (not statistically different, P = .106). The mean head-to-tail ratios on the affected and contralateral sides were 2.28 ± 0.49 (1.29-3.00) and 1.41 ± 0.22 (1.00-1.75; significantly different, P < .001). In all types 1A and 1B, the ratio was higher than 2.00; in 22 of 23 unaffected epididymides, the ratio was lower than 2.00. CONCLUSIONS Focal swelling of epididymal heads was a characteristic sonographic finding of mumps epididymo-orchitis, and a head-to-tail ratio higher than 2.00 can be a useful diagnostic finding.
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Affiliation(s)
- Seong Jin Park
- Department of Diagnostic Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea.
| | - Hyun Cheol Kim
- Department of Diagnostic Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Joo Won Lim
- Department of Diagnostic Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Sung Kyoung Moon
- Department of Diagnostic Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Sung Eun Ahn
- Department of Diagnostic Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea
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Materny J, Dymny M, Lesiewska L, Gawrych E. [Assessment of the validity of Doppler sonography in the diagnosis of acute scrotum in boys]. Pomeranian J Life Sci 2015; 61:163-166. [PMID: 27141600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE Comparison of preoperative scrotal Doppler sonography and final diagnosis of subsequent exploration in patients with acute scrotum. MATERIAL AND METHODS Retrospective analysis of the medical history of 61 patients operated on in The Department of Paediatric and Oncological Surgery in Szczecin in 2008-2014. RESULTS Mean patient age (years) with testicular torsion was 12.7 ± 4.0, with torsion of a testicular appendage was 8.6 ± 4.5, and with orchitis or epididymitis was 7.2 ± 8.5. During operation we diagnosed testicular torsion in 28 (45%) patients, torsion of the testicular appendage in 26 (43%), and orchitis or epididymitis in 7 (12%). The specificity of Doppler sonography for testicular torsion was 46%, for torsion testicular appendage 20%, and for orchitis/epididymitis 57%. CONCLUSIONS Doppler sonography of the scrotum shows limited specificity in the diagnosis of acute scrotum in boys. Surgical exploration is recommended even with apparently normal Doppler sonography examinations.
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Abstract
The purpose of this series was to describe the sonographic findings of tuberculous vasitis. We conducted a retrospective analysis of 3 cases of tuberculous vasitis. The following grayscale and color Doppler sonographic features were analyzed: location, echogenicity of the lesion, epididymal or testicular involvement, presence of hydrocele, and blood flow within the lesion. All 3 patients had focal (n = 2) or multifocal (n = 1) involvement of the scrotal segment of the vas deferens. The sonographic findings for tuberculous vasitis were heterogeneously hypoechoic in all of the cases. On color Doppler sonography, no blood flow was identified within the lesions of the vas deferens. All 3 patients had tuberculous epididymitis in addition to tuberculous vasitis. Tuberculous vasitis presents with infection along with tuberculous epididymitis, and it appears as a heterogeneously hypoechoic lesion in the scrotal segment of the vas deferens adjacent to the epididymal tail.
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Affiliation(s)
- Dal Mo Yang
- Department of Radiology, Kyung Hee University Hospital at Gangdong, 149 Sangil-Dong, Gangdong-Gu, Seoul 134-090, Korea. E-mail;
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Drudi FM, Valentino M, Di Leo N, Malpassini F, Cantisani V, Gnecchi M, Iori F. Color-/power doppler ultrasound imaging and ultrasound contrast media in acute scrotum - 2. Ultraschall Med 2013; 34:72-84. [PMID: 23386475 DOI: 10.1055/s-0032-1325563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- F M Drudi
- Department of Radiology, University La Sapienza, Viale Regina Elena 324, 00161 Rome, Italy.
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von Zastrow C. Pain may present in variable ways. Dtsch Arztebl Int 2013; 110:41. [PMID: 23413383 PMCID: PMC3566627 DOI: 10.3238/arztebl.2013.0041a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Affiliation(s)
- Patrick Günther
- *Sektion Kinderchirurgie, Klinik für Allgemein-, Viszeral- und, Transplantations-chirurgie, Universitätsklinikum Heidelberg,
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16
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Yusuf G, Sellars ME, Kooiman GG, Diaz-Cano S, Sidhu PS. Global testicular infarction in the presence of epididymitis: clinical features, appearances on grayscale, color Doppler, and contrast-enhanced sonography, and histologic correlation. J Ultrasound Med 2013; 32:175-180. [PMID: 23269723 DOI: 10.7863/jum.2013.32.1.175] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Epididymitis is common, presenting indolently with unilateral scrotal pain and swelling. Diagnosis is based on clinical assessment and resolves with antibiotic therapy. Recognized complications are abscess formation and segmental infarction. Global testicular infarction is rare. Diagnosis is important and requires surgical management. On grayscale sonography, global infarction may be difficult to establish. The addition of color Doppler imaging is useful but is observer experience dependent with limitations in the presence of low flow. Contrast-enhanced sonography is useful for unequivocally establishing the diagnosis. We report global testicular infarction in 2 patients with epididymitis clearly depicted on contrast-enhanced sonography, allowing immediate surgical management.
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Affiliation(s)
- Gibran Yusuf
- Department of Radiology, King’s College London, King’s College Hospital, London, England
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Abstract
Genitourinary tuberculosis, the second most common extrapulmonary tuberculosis (TB), is very difficult to diagnose unless one maintains a high index of suspicion. Isolated tuberculous epididymitis (ITE), defined as tuberculous epididymitis without clinical evidence of either renal or prostate involvement, is a rare entity among genitourinary tuberculosis. When diagnosed correctly, ITE can be cured with anti-TB medications. However, patients with poor response to medical treatment may require surgery. Here, we report a 20-year-old man who presented with a slow-growing painless scrotal tumor for 2 months, with the initial workup suspicious for a right paratesticular tumor. Surgical resection of the tumor was therefore scheduled. However, severe pain and redness over the patient's right hemi-scrotum were noted on the day of surgery. A repeat scrotal ultrasound was performed that revealed findings suggesting a chronic inflammatory process rather than a malignancy. Frozen section of the lesion confirmed the ultrasonographic findings, and the pathology established the diagnosis of ITE. The patient remained on anti-TB therapy postoperatively for 6 months and had an excellent outcome.
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Affiliation(s)
- Victor Ka-Siong Kho
- Division of Urology, Department of Surgery, Far Eastern Memorial Hospital and Medical Center, Banciao, New Taipei City, Taiwan, ROC
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18
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Manchanda S, Sharma BB, Kumar S. Tuberculous epididymo-orchitis: MRI appearance. Urol J 2012; 9:351. [PMID: 22395829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Smita Manchanda
- Department of Radiodiagnosis, PGIMER and Dr RML Hospital, New Delhi, India.
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La Vignera S, Vicari E, Condorelli R, D'Agata R, Calogero AE. Hypertrophic-congestive and fibro-sclerotic ultrasound variants of male accessory gland infection have different sperm output. J Endocrinol Invest 2011; 34:e330-5. [PMID: 22234181 DOI: 10.1007/bf03346729] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Male accessory gland infection (MAGI) exerts a negative influence on male fertility which depends upon its extension. Indeed, we have shown that patients with MAGI involving prostate, seminal vesicles and epididymis have worse sperm parameters compared with patients with prostatitis alone or prostate-vesiculitis. Similarly, MAGI extending bilaterally is associated with a worse sperm output. The aims of this study were to evaluate the prevalence of two different additional ultrasound (US) findings (hypertrophic- congestive and a fibro-sclerotic US form) and to evaluate their semen quality. MATERIALS AND METHODS One hundred infertile patients with MAGI, diagnosed according to the World Health Organization (WHO) 1993 criteria, were evaluated by scrotal and transrectal ultrasound scans. The control group consisted of 100 healthy, age-matched men. RESULTS The ultrasound examination confirms two separate US variants of MAGI: a hypertrophic-congestive (prevalence of 56%) and a fibro-sclerotic form (prevalence of 29%). Patients with hypertrophic-congestive MAGI showed higher sperm concentration, motility and normal forms, but also higher sperm leukocytes concentration and seminal reactive oxygen species compared to patients with fibro-sclerotic MAGI. However, all these parameters were significantly worse than those observed in the control group. DISCUSSION Infertile patients with hypertrophic-congestive MAGI have a better sperm quality compared with patients with fibrosclerotic MAGI; however, they showed higher oxidative stress in semen.
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Affiliation(s)
- S La Vignera
- Section of Endocrinology, Andrology and Internal Medicine, and Master in Andrological, Human Reproduction and Biotechnology Sciences, Department of Internal Medicine and Systemic Diseases, University of Catania, 95123 Catania, Italy.
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Yilmaz O, Yilmaz S, Kisacik B, Aydogdu M, Bozkurt Y, Erdem H, Pay S, Saglam M, Dinc A. Varicocele and epididymitis in Behcet disease. J Ultrasound Med 2011; 30:909-913. [PMID: 21705723 DOI: 10.7863/jum.2011.30.7.909] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Behçet disease is a systemic disease with protean manifestations. Vasculitis is a hallmark of the disease and may involve arteries, veins, and capillaries. Varicocele is dilatation of the pampiniform plexus veins. We aimed to investigate the incidence of varicocele in patients with Behçet disease. METHODS The study included 47 male patients with Behçet disease and 31 healthy control participants. All underwent a clinical evaluation including a medical history and systemic and scrotal examinations. Subsequently, 2 investigators blinded to the clinical data performed sonographic examinations and measured pampiniform plexus vein diameters. RESULTS The mean age of the patients ± SD was 23.4 ± 3.2 years; disease durations ranged from 3 to 120 months (46 ± 31 months). Scrotal pain or a palpable mass was detected by clinical examination in 24 patients with Behçet disease (51.1%) and 5 healthy participants (16.1%; P = .002). By color Doppler examination, left varicocele was diagnosed in 26 patients with Behçet disease (55.3%) and 9 healthy participants (29%; P = .02). All patients with right varicocele also had left varicocele; that condition was detected in 10.6% (5 patients) of the Behçet disease group and 6.4% (2 patients) of the control group (P > .05). Eight patients with Behçet disease (17%) had epididymitis, whereas none of the healthy participants did (P = .019, Fisher exact test). Genital ulcers and erythema nodosum lesions were more common among patients with varicocele (P = .034 and .058, respectively). There were no differences in smoking, epididymitis, arthritis, uveitis, or other clinical parameters for distinguishing varicocele in patients with Behçet disease. CONCLUSIONS The incidence of varicocele was increased in Behçet disease. Whether varicocele confers fertility problems in patients with Behçet disease and the underlying mechanism for a possible association are yet to be determined.
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Affiliation(s)
- Omer Yilmaz
- Division of Radiology, Gulhane School of Medicine, Etlik, 06018 Ankara, Turkey.
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Pisklakov AV. [A rare cause of recurrent orchoepididymitis in a child]. Urologiia 2011:73-74. [PMID: 21815462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Abstract
OBJECTIVE The purpose of this study was to describe the sonographic findings of acute vasitis. METHODS This was a retrospective analysis of 12 cases of acute vasitis. The following gray scale and color Doppler sonographic features were analyzed: location, echogenicity of the lesion, presence of hydrocele, epididymal involvement, and blood flow within the lesion. RESULTS Of the 12 patients, 10 had acute vasitis in the scrotal segment; 1 had acute vasitis in the suprascrotal segment; and 1 had acute vasitis in both the scrotal and suprascrotal segments. The sonographic finding for acute vasitis of the scrotal segment was a heterogeneously hypoechoic appearance of the vas deferens (n = 11). The vas deferens was thickened (6.4 mm in diameter) in the 2 patients with suprascrotal involvement; it was heterogeneously hypoechoic in 1 and had a normal appearance in the other. On color Doppler sonography, the degree of blood flow was increased in all of the cases. Of the 12 patients, 11 had inflammation of the epididymis. CONCLUSIONS Acute vasitis usually presents with infection combined with acute epididymitis, and it usually appears as a heterogeneously hypoechoic lesion in the scrotal segment, suprascrotal segment, or both.
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Affiliation(s)
- Dal Mo Yang
- Department of Radiology, Kyung Hee University East-West Neo Medical Center, Seoul, Korea.
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Fry E, Counselman FL. A right scrotal abscess and foreign body ingestion in a schizophrenic patient. J Emerg Med 2010; 38:587-592. [PMID: 18155384 DOI: 10.1016/j.jemermed.2007.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2006] [Revised: 02/01/2007] [Accepted: 03/22/2007] [Indexed: 05/25/2023]
Abstract
A 38-year-old man with a history of schizophrenia presented with pain and swelling of his testicles, with the right side worse than the left. Physical examination was remarkable for a very firm, large, right-sided scrotal mass. Testicular ultrasound was suspicious for neoplasm or abscess. On the pelvic computed tomography (CT) scan, which was obtained as part of a metastatic cancer work-up, two metallic foreign bodies were identified in the pelvis. On further questioning, the patient admitted to ingesting the nails 2 days prior, in a suicide attempt. We review the evaluation of unilateral scrotal pain and swelling, and incidental foreign body ingestion.
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Affiliation(s)
- Emily Fry
- Department of Emergency Medicine, Eastern Virginia Medical School, Norfolk, Virginia, USA
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Bizimi V, Balanika AP, Motogna-Kalokairinou M, Paianidi I, Kardamis S, Kominis C, Baltas CS. Focal, asymptomatic epididymal masses--B-mode and color Doppler sonographic evaluation. Case report. Med Ultrason 2010; 12:163-166. [PMID: 21173947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We reported the case of an adult male with an extratesticular mass prove to be postoperative a chronic inflammatory process. The importance of B-mode and color Doppler sonography in the differential diagnosis and literature regarding epididymal nodules and tumors of the paratesticular structures (epididymis) is reviewed and discussed.
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Affiliation(s)
- Vasiliki Bizimi
- Radiology Imaging Department, General Hospital of Athens G.Gennimatas, 9 Odysseos St, Heliopolis, 16346 Athens, Greece.
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25
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Yang DM, Kim HC, Jin W, Lee HL, Kim GY. Lymphoma of the testis and epididymis mimics chronic inflammation upon sonography. J Clin Ultrasound 2009; 37:242-244. [PMID: 18972362 DOI: 10.1002/jcu.20536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We report the sonographic findings in a case of lymphoma, which mimicked chronic inflammation. Scrotal gray-scale sonography revealed an irregularly margined, hypoechoic mass in the right testis and epididymis. Color Doppler sonography showed increased blood flow within the hypoechoic lesions in both testis and epididymis. Pathologic examination revealed a diffuse involvement of the testis and epididymis.
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Affiliation(s)
- Dal Mo Yang
- Department of Radiology, Urology, and Pathology, Kyung Hee University East-West Neo Medical Center, Gangdong-Gu, Seoul, South Korea
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Hoag N, Pommerville PJ, Kibsey PC, Cavers DJ, Eddy RJ. Tuberculous epididymitis following intravesical Bacillus Calmette-Guérin immunotherapy. Can J Urol 2009; 16:4589-4591. [PMID: 19364433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Intravesical Bacillus Calmette-Guérin (BCG) is widely used as an adjuvant therapy in the treatment of superficial bladder cancer. BCG is administered as a live, attenuated form of Mycobacterium bovis, and acts as an immunomodulary agent to delay tumor progression. BCG is generally well tolerated, though localized and systemic infectious complications may occur. A literature search revealed that tuberculous epididymitis is a rarely reported complication of intravesical BCG therapy. We report the case of an 82-year-old male who developed tuberculous epididymitis while undergoing intravesical BCG treatment for transitional cell carcinoma of the bladder. Right orchiectomy was performed, followed by rifampin and isoniazid therapy once M. bovis was identified as the infectious agent. The patient responded well to these treatments, and made a full recovery. Tuberculous epididymitis is an uncommon complication resulting from intravesical BCG therapy, which is likely explained by retrograde migration from the prostatic urethra in this case.
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Affiliation(s)
- Nathan Hoag
- Department of Urologic Sciences, University of British Columbia (Island Medical Program), Victoria, BC, Canada
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Gerscovich EO, Bateni CP, Kazemaini MR, Gillen MA, Visis T. Reversal of diastolic blood flow in the testis of a patient with impending infarction due to epididymitis. J Ultrasound Med 2008; 27:1643-1646. [PMID: 18946105 DOI: 10.7863/jum.2008.27.11.1643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Eugenio O Gerscovich
- Department of Radiology, University of California, Davis Medical Center, Sacramento, CA 95817 USA.
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29
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Briceño-García EM, Gómez-Pardal A, Alvarez-Bustos G, Artero-Muñoz I, Molinero MM, Seara-Valero R, Moreno-Ramírez V. Tuberculous orchiepididymitis after BCG therapy for bladder cancer. J Ultrasound Med 2007; 26:977-9. [PMID: 17592062 DOI: 10.7863/jum.2007.26.7.977] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
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30
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Wilson SR, Katz DS. Computed tomography demonstration of epididymitis with extension to vas deferens. Urology 2006; 68:1339-40. [PMID: 17141825 DOI: 10.1016/j.urology.2006.08.1083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2006] [Revised: 05/25/2006] [Accepted: 08/17/2006] [Indexed: 11/23/2022]
Affiliation(s)
- Sean R Wilson
- Department of Diagnostic Radiology, Winthrop University Hospital, Mineola, New York 11501, USA.
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Abstract
Brucellosis is a zoonotic disease caused by Brucella sp. and may affect many parts of the body. Brucella epididymo-orchitis had been reported in up to 20% of patients with brucellosis. This is a case report of Brucella epididymo-orchitis in a Saudi male patient. He presented with a unilateral swelling of the left testicle. He had fever, arthralgia and night sweats. Ultrasound examination revealed enlarged left epididymis and testicle. Brucella serology was positive and the patient responded to treatment with doxycycline and gentamicin. Thus, brucella infection should be considered in the differential diagnosis of patients presenting with epididymo-orchitis from an endemic area.
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Affiliation(s)
- Jaffar A Al-Tawfiq
- Internal Medicine Services Division, Dhahran Health Center, Saudi Aramco Medical Services Organization, Saudi Aramco, Dhahran, Saudi Arabia.
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32
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Stuckmann G. [Ultrasound of the scrotum]. Praxis (Bern 1994) 2006; 95:709-20. [PMID: 16722401 DOI: 10.1024/0369-8394.95.18.709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Ultrasound is an excellent tool for the diagnosis of benign or malignant intra- and extratesticular lesions depending on their structure and location in the scrotum. Besides the sonographic appearance, the clinical history and the location of a scrotal mass is crucial for the differential diagnosis between benign and malignant masses. In cases of acute scrotum or of vascular and inflammatory lesions, Doppler ultrasound is mandatory. This article gives a systematical survey of the most frequent scrotal lesions and their appearance in ultrasound.
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Affiliation(s)
- G Stuckmann
- Institut für Radiologie, Kantonsspital Winterthur
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33
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Karmazyn B, Steinberg R, Livne P, Kornreich L, Grozovski S, Schwarz M, Ziv N, Freud E. Duplex sonographic findings in children with torsion of the testicular appendages: overlap with epididymitis and epididymoorchitis. J Pediatr Surg 2006; 41:500-4. [PMID: 16516624 DOI: 10.1016/j.jpedsurg.2005.11.046] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND PURPOSE Torsion of the testicular appendages (TTA) is the most common cause of acute scrotum in children, and yet there are only few dedicated studies of the imaging findings. OBJECTIVE To review our experience with the use of duplex sonography in children with TTA and to evaluate if sonography can successfully distinguish TTA from epididymoorchitis. METHODS We reviewed the medical files and imaging findings of 29 children aged 0.7 to 13.9 years (mean, 6.5 years) with a diagnosis of TTA based on testicular exploration who were evaluated preoperatively with duplex sonography. RESULTS A tender upper pole nodule, the typical sign of TTA, was palpated in only 2 (6.9%) children. Duplex sonography demonstrated an extratesticular upper pole nodule in 9 (31%) children. Secondary inflammatory changes included hydrocele in 22 (75.9%), enlarged epididymis in 22 (75.9%), scrotal wall edema in 16 (55.2%), and swollen testis in 9 (31%) children. Fourteen (48%) children had inflammatory changes with no evidence of an extratesticular nodule. CONCLUSION Duplex sonography findings of secondary inflammatory changes in the absence of evidence of an extratesticular nodule may suggest an erroneous diagnosis of epididymitis or epididymoorchitis in children with TTA.
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Affiliation(s)
- Boaz Karmazyn
- Department of Imaging, Schneider Children's Medical Center of Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 49202, Israel.
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Affiliation(s)
- Iain P Wharton
- Department of Urology, University Hospital of North Staffordshire NHS Trust, City General Hospital, Stoke-on-Trent, Staffordshire ST4 6QG, UK.
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Affiliation(s)
- Jose C Estepa
- Department of Medicina y Cirugia Animal, Universidad de Cordoba, Campus de Rabanales, Ctra Madrid-Cadiz km 396, 14014 Cordoba, Spain
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Li SQ, Li XS, Dong YL, Shan GZ, He ZJ, Jin J, Guo YL, Na YQ. [Diagnosis and differential diagnosis value of ultrasound in epididymal mass]. Zhonghua Nan Ke Xue 2006; 12:164-6, 170. [PMID: 16519159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
OBJECTIVE To elevate the diagnosis and differential diagnosis levels of epididymal mass by sonography. METHODS This was a retrospective study of 179 cases of epididymal mass treated by surgery in our hospital between 1990 and 2005. The analysis was focused on pathological and sonographic features. RESULTS 179 patients with mean age of 51.4 +/- 14.7 were enrolled. The epididymal mass was classified into four groups: epididymal cyst (n = 98), nonspecific epididymitis (n = 27), tuberculous epididymitis (n = 33) , and epididymal tumor (n = 21). Epididymal cyst could be easily diagnosed by ultrasound, the diagnostic rate was 93.8%, but nonspecific epididymitis and tuberculous epididymitis were hard to differentiate, complicating with multiple organs lesions may distinguish tuberculous from nonspecific epididymitis. Tuberculous epididymitis could be easily diagnosed when cold abscess, calcification and sinus tract emerged. The majority epididymal tumors were benign, and malignant cases were rarely seen. Patient's history, physical examination and sonographic features were all essential to make a right diagnosis. CONCLUSION Ultrasound features may be helpful to the differential diagnosis of epididymal mass and ultrasound should be the first choice of image detection in epididymal lesions.
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Affiliation(s)
- Shu-Qing Li
- Institute of Urology, Peking University First Hospital, Beijing 100034, China.
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37
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Affiliation(s)
- Malai Muttarak
- Department of Radiology, Chiang Mai University, Chiang Mai, Thailand
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Liu CH, Jing QH, Ma B, Zhang AH, Ma YNE, Peng GJ, Wang JW. [Sonographical features of the epididymis tuberculosis with caseous necrosis]. Zhonghua Nan Ke Xue 2005; 11:912-4, 917. [PMID: 16398362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To analyse sonographical features of epididymis tuberculosis with caseous necrosis and improve the accuracy of ultrasonic diagnosis. METHODS Ultrasonic features of 12 cases with epididymis tuberculosis with caseous necrosis, confirmed by surgical pathology, was retrospectively analysed: size, location, echogenicity, degree of blood flow in the lesion. RESULTS In all 12 patients, the number of purified protein derivative test (PPD) presenting the positive reached to 67%, while cases with the pulmonary tuberculosis was 42%. The epididymal tuberculosis with caseous necrosis could present images of the whole or focal epididymal enlargement and abnormal shape. The lesions internal echoes were irregular, inhomogeneous increased isoechoic echogenicity or hypoechoic, including bad-defined, irregular, homogeneous hypoechoic or anechoic. In lesional location, 4 out of 12 patients (33%) possessed richly color blood flow in Color Doppler Power Imaging(CDPI). The testicular enlargement with increased internal echoes and the testicular hydroceles were partly (58%, 7/12) observed by ultrasound. There was no varicocele, scrotal wall thickening and inguinal lymph node enlargement. CONCLUSION The High Frequency Color Doppler images is helpful for the diagnosis and differential diagnosis of epididymis tuberculosis with caseous necrosis.
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Affiliation(s)
- Chun-hong Liu
- Department of Ultrasound of Imaging Center, the Second Affiliated Hospital, Xinjiang Medical University, Urumqi, Xinjiang 830028, China.
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Ozturk A, Ozturk E, Zeyrek F, Onur K, Sirmatel O, Kat N. Comparison of brucella and non-specific epididymorchitis: gray scale and color Doppler ultrasonographic features. Eur J Radiol 2005; 56:256-62. [PMID: 16233893 DOI: 10.1016/j.ejrad.2005.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2004] [Revised: 01/02/2005] [Accepted: 01/12/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of this study is to find out if it is possible to differentiate between brucellar and non-specific epididymorchitis by comparing ultrasonography (US) and color Doppler ultrasonography (CDUS) findings. MATERIAL AND METHODS Fifty-six patients diagnosed to have epididymorchitis both clinically and ultrasonographically were included to study. All of the patients were investigated serologically for brucella. Twenty-eight of those patients were admitted brucella epididymorchitis because of high agglutinations titers for brucella. The other 28 patients were admitted non-specific epididymorchitis because of normal agglutinations titers for brucella. Testicular size, echogenicity, hydrocele, internal echoes and/or septations within hydrocele, and scrotal skin thickness of normal and involved testis were compared by ultrasonography. Besides, pick systolic velocity, end diastolic velocity, resistive index and pick systolic velocity ratio values were measured by bilateral testicular color Doppler ultrasonography in both groups. When the p-value is <0.05, the difference between groups is accepted as statistically significant. RESULTS Thickening of scrotal skin was seen in 17 of 28 patients with brucella epididymorchitis (BEPO) (67%) and in 25 of 28 patients with non-specific epididymorchitis (NEPO) (89.2%) (p < 0.01). There was no difference between groups regarding presence of hydrocele. However hydrocele seen in all patients was anechoic except for two patients (8.6%). Hydrocele seen in 18 of 22 patients with BEPO and hydrocele had internal echogenicity or septation (p < 0.001). Sizes of testes and epididymis were found to be increased in involved testis compared to normal testis. Testes of all patients with NEPO were homogenous with decreased echogenicity except for five patients (17.8%). However, 23 patients with BEPO (82%) found to have heterogenous testis (p < 0.001). Spectral measurements showed increased PSV and EDV values and decreased RI values in involved sides in both groups. There was statistical significant difference in respect to maximum and minimum flow velocity between two groups (p < 0.05). There was no difference between the two groups regarding RI values. PSV ratio was 3.1+/-1.3 in patients with BEPO and 2.2+/-0.7 in patients with NEPO. CONCLUSION Heterogenicity, focal echogenicity differences and hydrocele with granularity and/or septation seen in a patient presenting with scrotal infection in brucella endemic areas must rise the possibility of brucellosis rather than NEPO. By this way, effective treatment can commence immediately and complications can be avoided.
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Affiliation(s)
- Adil Ozturk
- Department of Radiology, Harran University School of Medicine, Arastirma ve Uygulama Hastanesi, TR-63100 Sanliurfa, Turkey.
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Abstract
We aimed to describe the morphologic characteristics of the appendix epididymis that appears cystic on ultrasound (US) examinations. Two hundred and seventy-two patients (544 testes) were examined by US for various scrotal complaints. The patients were prospectively evaluated for the presence of testicular appendages. Cystic appendix epididymis on US examinations was classified according to the presence of the stalk and size of the cyst. Testicular appendages have been identified in 337 out of 544 testes (61.9%). Of them, 241 were appendix testis (44.3%) and 96 (17.6%) were appendix epididymis. Of the appendix epididymises, 35 were cystic in nature (36.4%). The most common morphology in our study was the stalked appendix epididymis with nonseptated unilocular cysts (31.4%). In conclusion, cystic appearance of the appendix epididymis on sonographic examinations is frequent and it should not be mistaken with a torsed testicular appendage.
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Affiliation(s)
- Fatih Kantarci
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, 34300 Istanbul, Turkey.
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41
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Affiliation(s)
- Monique Mogensen
- Department of Radiology, Stanford University Medical Center, California, USA
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Muttarak M, Lojanapiwat B. The painful scrotum: an ultrasonographical approach to diagnosis. Singapore Med J 2005; 46:352-7; quiz 358. [PMID: 15968450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Many disease processes, including inflammation, testicular torsion, testicular trauma, and testicular cancer, may have a similar clinical presentation as a painful scrotum. Differentiation of these disease processes is important for proper management. High-resolution ultrasonography (US) combined with colour Doppler ultrasonography (CDUS) is the imaging modality of choice in evaluating these patients. Gray-scale US helps to better characterise scrotal lesions. CDUS demonstrates testicular perfusion which aids in reaching a specific diagnosis. This pictorial essay is intended to review the causes, US appearances of disease processes causing the painful scrotum, and examination pitfalls of scrotal US.
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Affiliation(s)
- M Muttarak
- Department of Radiology, Chiang Mai University, 110 Intavaroros Road, Chiang Mai 50200, Thailand.
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Luo XY, Tu WX, Lü XX. [Color Doppler flow imaging for diagnosis of scrotal disease: clinical analysis of 76 cases]. Di Yi Jun Yi Da Xue Xue Bao 2005; 25:736-8. [PMID: 15958326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To evaluate the value of color Doppler flow imaging (CDFI) in the diagnosis of testicular torsion, epididymitis, testitis, varicocele and testicular trauma. METHODS The morphological changes of the testis and internal echo were displayed with two-dimentional ultrasound, and the blood perfusion in the testis was observed with color Doppler. The diagnoses were confirmed by operation and pathological examination or clinical follow-up. RESULTS CDFI demonstrated reduction or disappearance of blood supply in the testis in 3 cases of testicular torsion, and increased blood flow was shown in 8 cases of testitis, 26 cases of epididymitis and 30 cases of. Nine cases of testicular trauma showed some spot-like blood supply or blood supply reduction in the testis. CONCLUSION CDFI is an inexpensive, practicable, reliable, and noninvasive method for diagnosing scrotal disease with reproducible results.
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Affiliation(s)
- Xiao-yan Luo
- Department of Ultrasound, Songgang People's Hospital, Shenzhen 518105, China
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45
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Abstract
OBJECTIVE To determine the relative importance of clinical presentation, laboratory studies, and ultrasonography in the diagnosis of acute scrotum, and to suggest an effective method of management. SUBJECTS AND METHODS Forty patients who were hospitalized between January 2002 and December 2002 for acute scrotum were studied with respect to history, physical examination, blood tests, urine analysis including culture, and scrotal ultrasonography with color Doppler study. RESULTS Epididymitis (n = 24) was the commonest cause of acute scrotum followed by testicular torsion (n = 11), torsion of testicular appendages (n = 4), and idiopathic scrotal edema (n = 1). Both mean age (40.7 vs. 13.8 years), and average duration of pain at presentation (4.5 days vs. 19.1 h) were higher in patients with epididymitis than in torsion. Onset was usually insidious in epididymitis, sudden in testicular torsion, and variable in torsion of testicular appendages. The majority (87.5%) of patients with epididymitis were managed conservatively. The testis was salvaged in 81.8% of patients with testicular torsion. The accuracy of ultrasonography was only 72.7% in testicular torsion, but was good in epididymitis. CONCLUSION Our results show that a careful clinical evaluation, by an experienced examiner, provides the correct diagnosis in acute scrotum rather than ultrasonography. It is of utmost importance to exclude testicular torsion in those who are younger than 16 years and whose pain duration is less than 24 h.
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Affiliation(s)
- Fawzi Abul
- Department of Surgery, Faculty of Medicine, Kuwait University, Safat, Kuwait
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Abstract
OBJECTIVE The purpose of our study was to determine the size and appearance of normal and torsed testicular appendages on color Doppler sonography. SUBJECTS AND METHODS Thirty-three patients with acute scrotal pain underwent gray-scale and color Doppler sonography and subsequent surgery. Twenty-two patients had torsion of the appendix testis, six had epididymitis, three had torsion of the testis, and two had torsion of the appendix epididymidis. The testicular appendages of 30 patients and the testes of three were excised and sent to the laboratory for histopathologic examination. RESULTS A testicular appendage was identified on color Doppler sonography in 23 patients (21 patients with torsed appendages and two patients with epididymitis). The torsed appendixes testis measured from 4.1 to 16.3 mm, and the normal appendixes in the two patients with epididymitis measured 4.1 and 5.6 mm. With the visualization of an appendix larger than 5.6 mm as the sonographic diagnostic criterion for torsion of a testicular appendage, sensitivity was 68.2% (95% confidence interval (CI), 45.1-85.3%), and specificity was 100% (CI, 74.7-100%). CONCLUSION The identification of a testicular appendage larger than 5.6 mm is suggestive of torsion. Therefore, depending on the patients' clinical conditions, these cases can be treated conservatively when an appendage larger than 5.6 mm is identified.
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Affiliation(s)
- Matteo Baldisserotto
- Hospital da Criança Conceição, Ministério da Saúde, Brazil, Eca de Queiroz 384, Apt. 502, Porto Alegre, RS, Brazil, 90.670-020.
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Coulier B, Ramboux A, Maldague P. Emphysematous epididymitis as presentation of unusual seminal vesicle fistula secondary to sigmoid diverticulitis: case report. ACTA ACUST UNITED AC 2004; 30:113-6. [PMID: 15647880 DOI: 10.1007/s00261-004-0216-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2004] [Accepted: 02/18/2004] [Indexed: 12/29/2022]
Abstract
This case report describes a sigmoid diverticulitis with torpid development, long-term symptoms of bladder irritability, and an emphysematous epididymitis caused by a direct seminal vesicle fistula. The diagnosis was suggested by scrotal ultrasound visualizing gas in the scrotum; the complex pelvic fistulous tract was specifically delineated by multislice computed tomography. This may be the first reported case of seminal vesicle fistula directly related to colonic diverticulitis and causing emphysematous epididymitis.
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Affiliation(s)
- B Coulier
- Departments of Diagnostic Radiology, Clinique St Luc, Rue St Luc 8, 5004, Bouge (Namur), Belgium.
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48
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Abstract
Accurate and early diagnosis of acute scrotum is of the utmost importance to avoid testicular loss and/or needless surgery. The aim of this study is to analyze the clinical presentation and physical examination parameters together with the results of imaging studies in order to find out predictors for the differential diagnosis of acute scrotum with special emphasize on testicular torsion (TT). Patients who were treated for acute scrotum in our unit from 1970 up to and including 2000 were reviewed retrospectively. The study group was subdivided into three groups: "testicular torsion (TT)", "torsion of testicular appendage (TTA)", and "epididymoorchitis (EO)" group according to the diagnosis confirmed by radiologic and surgical findings. Presence and/or absence of various parameters related to clinical presentation, physical examination, and results of imaging studies were analyzed by statistical means in each group. One hundred and sixty children with a mean age of 12.2 years formed the study group. The mean duration of symptoms was 15 hours. No significant difference was noted between the three groups with regard to mean age and duration of symptoms. Nuclear scintigraphy and Doppler ultrasound were used as diagnostic aids in 50 and 66 children, respectively. Clinical presentation parameters including the presence of a) previous trauma, b) pain attacks, and c) nausea and vomiting, had the highest sensitivity, specificity, positive and negative predictive values in the TT group and the lowest values in the EO group. In contrast, the EO group had the highest statistical values with regard to presence of dysuria and micturition disorders. Physical examination parameters consisting of a) elevation, b) transverse location of testis, c) anterior rotation of epididymis, and d) absence of cremasteric reflex had the highest statistical values in the TT group. Contrary to this, imaging studies had the highest specificity and positive predictive values in the TTA group and the lowest values in the TT group. Previous history of trauma and pain attacks, presence of nausea and vomiting, and absence of urinary complaints are the main predictors of TT. Elevation and transverse location of testis with an anteriorly rotated epididymis associated with loss of ipsilateral cremasteric reflex strongly indicate TT. Although accuracy of imaging studies is higher for the differential diagnosis of TTA and EO, there is a considerable risk of misdiagnosis. Therefore, differential diagnosis of acute scrotum, particularly TT, still remains a clinical diagnosis, and clinical parameters deserve more importance in surgical decision making.
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Affiliation(s)
- A O Ciftci
- Department of Pediatric Surgery, Hacettepe University Medical Faculty, Ankara, Turkey.
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49
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Abstract
Acute scrotal pain makes up approximately 0.5% of all complaints presenting to an emergency department. Some of the most com-mon diagnoses for this complaint are testicular torsion and epididymitis. Misdiagnosing testicular torsion can lead to organ loss,cosmetic deformity, and compromised fertility. Modem ultrasound examination of the scrotum is the test of choice for acute scrotal pathology and yields high accuracy compared with surgical exploration. A key component of the testicular examination is use of power and spectral Doppler ultrasonography. Examination of the acute scrotum should not be undertaken unless Doppler capability is available because the evaluation of blood flow is such an important part of diagnosis of testicular torsion, orchitis, epididymitis,trauma, and hemorrhage into a mass.
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Affiliation(s)
- Michael Blaivas
- Section of Emergency Ultrasound, Department of Emergency Medicine, Medical College of Georgia, 1120 15th Street, AF-2039, Augusta, GA 30912-4007, USA.
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50
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De Backer AI, Mortelé KJ, De Roeck J, Ros PR, De Keulenaer BL, Vanschoubroeck IJ, Bomans P. Tuberculous epididymitis associated with abdominal lymphadenopathy (2004:1b). Eur Radiol 2004; 14:748-51. [PMID: 15085800 DOI: 10.1007/s00330-003-1943-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although the predominant form of tuberculosis is pulmonary disease, an increasing number of cases with extra-pulmonary involvement have been reported. The diagnosis of extra-pulmonary tuberculosis is often difficult because of its protean clinical manifestations and non-specific laboratory findings. Abdominal lymph node involvement may be present alone or in combination with involvement of the gastrointestinal tract, peritoneum, and solid viscera. Tuberculous epididymitis occurs sporadically and represents a specific secondary subacute or chronic inflammatory process involving the epididymis. We present the imaging findings in a patient with tuberculous epididymitis associated with abdominal tuberculous lymphadenopathy.
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Affiliation(s)
- A I De Backer
- Department of Radiology, Algemeen Centrumziekenhuis Antwerpen, Campus Stuivenberg, Belgium.
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