Global Testicular Infarction in the Presence of Epididymitis
|
|
- Bonnie Pope
- 5 years ago
- Views:
Transcription
1 CASE SERIES Global Testicular Infarction in the Presence of Epididymitis Clinical Features, Appearances on Grayscale, Color Doppler, and Contrast-Enhanced Sonography, and Histologic Correlation Gibran Yusuf, MBBS, Maria E. Sellars, MBBS, FRCR, Gordon G. Kooiman, MBBS, FRCS, Salvador Diaz-Cano, MD, PhD, FRCPath, Paul S. Sidhu, BSc, MRCP, FRCR 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. Key Words Doppler sonography; epididymitis; infarction; microbubble contrast; testis Received May 15, 2012, from the Departments of Radiology (G.Y., M.E.S., P.S.S.), Urology (G.G.K.), and Pathology (S.D.-C.), King s College London, King s College Hospital, London, England. Revision requested May 30, Revised manuscript accepted for publication June 13, Address correspondence to Paul S. Sidhu, BSc, MRCP, FRCR, Department of Radiology, King s College London, King s College Hospital, Denmark Hill, London SE5 9RS, England. paulsidhu@nhs.net E pididymitis is one of the most common urologic disorders and usually presents indolently with unilateral scrotal pain and swelling. The diagnosis is often based on clinical symptoms and examination, with resolution of symptoms after appropriate antibiotic therapy. If symptoms fail to resolve, with continuing pain a particular concern, sonography is performed to ascertain the presence of an indolent abscess or, more rarely, the presence of segmental infarction, a recognized but rare complication of severe epididymitis. 1 Both of these complications are readily identified on grayscale sonography, with color Doppler imaging aiding the delineation of an abscess within the inflamed epididymis or testis or focal segmental infarction within the testis. 2 With the advent of microbubble contrast agents, the technique of contrast-enhanced sonography has also been shown to be useful in identifying areas of segmental infarction 3 and abscess formation. 4 With segmental infarction, the clinical management is normally conservative, with resolution occurring over time, albeit with testicular atrophy often resulting. In the presence of a testicular or epididymal abscess, careful manipulation of antibiotic therapy will often result in resolution, but serial sonographic examinations are needed to confirm improvement or expedite surgical intervention. Global testicular infarction as a consequence of epididymitis is exceedingly rare, with only 4 cases described in the literature. 5 8 Global infarction is often a difficult diagnosis to establish unequivocally on sonography. The advent of contrast-enhanced sonography, with the ability to exquisitely show vascularity, may be a useful adjuvant for establishing the diagnosis by the American Institute of Ultrasound in Medicine
2 We report the occurrence of global testicular infarction in 2 patients with epididymitis clearly depicted on contrast-enhanced sonography, allowing immediate definitive surgical management to alleviate symptoms. Case Descriptions Case 1 A 55-year-old man with a history of resected colorectal cancer was seen in a preassessment clinic for stoma reversal. The patient had vague lower urinary tract symptoms for 3 days and was treated with appropriate antibiotics after isolation of Eschericha coli in the urine. After a 3-day course of antibiotics, he presented to the emergency department febrile and with increased pain in the right hemiscrotum and suprapubic region. On clinical examination, there was a tender erythematous swollen right hemiscrotum. Hematologic and biochemical screening revealed neutrophilia and a raised C-reactive protein level. A diagnosis of epididymitis was made, and the patient was admitted to hospital. On grayscale sonography, a thickened edematous right scrotal wall, a right-sided septated hydrocele, and an enlarged epididymis were identified. The underlying right testis was of uniform reflectivity, equivalent to the reflectivity of the left testis, with no focal lesions identified and no evidence of changes to suggest orchitis (Figure 1A). Color Doppler sonography showed an increased color signal in the epididymis, in keeping with inflammation, with no evidence of any color Doppler signal within the testis (Figure 1B). Further imaging with contrast-enhanced sonography (SonoVue, 4.8 ml; Bracco SpA, Milan, Italy) using a 9L linear transducer and an Acuson S2000 system (Siemens Medical Solutions, Mountain View, CA) was performed, showing an avidly enhancing right epididymis with no contrast enhancement of the entire right testis (Figure 1C). Based on the confirmation of the absence of blood flow on contrast-enhanced sonography, a diagnosis of global right testicular infarction secondary to epididymitis was suggested. The patient underwent immediate exploratory surgery, during with 50 ml of pus was drained, and a right orchidectomy was performed. Histologic examination revealed that the epididymis was inflamed with multiple microabscesses. Although macroscopically the right testis appeared normal, microscopically, ischemia of the entire testis was present but was unaffected by the adjacent inflammatory change (Figure 1, D and E). The patient had an uneventful recovery and remained well on follow-up. Case 2 A 64-year-old man with a history of type 2 diabetes mellitus, ischemic heart disease, and hypertension presented to his general practitioner with symptoms of left hemiscrotal swelling and pain of 2 days duration. The patient was treated with antibiotics, and sonography at the time showed inflammation of the left epididymis and normal appearances and vascularity in both testes. Persisting pain for 2 more days led to presentation to the emergency department, where he was found to have neutrophilia and a raised C-reactive protein level. A further sonographic examination showed increased vascularity in the epididymis again with normal appearances to the testis, but an associated hydrocele had developed. The patient was admitted to the hospital and, despite intravenous antibiotics, failed to improve. A third sonographic examination was performed. On grayscale imaging, the left epididymis was thickened with focal areas of low reflectivity identified. The underlying left testis was of uniform reflectivity, equivalent to the reflectivity of the right testis, with no focal lesions or evidence of orchitis. Surrounding the left testis was a septated hydrocele (Figure 2A). Color Doppler sonography showed an increased signal in the epididymis, in keeping with inflammation. There was no evidence of any color Doppler signal within the left testis (Figure 2B). Further imaging with contrast-enhanced sonography (SonoVue, 4.8 ml) using a 9L linear transducer and an Acuson S2000 system was performed, showing an avidly enhancing left epididymis with no contrast enhancement of the entire left testis (Figure 2C). Based on the confirmation of the absence of blood flow on contrast-enhanced sonography, a diagnosis of global left testicular infarction secondary to epididymitis was suggested. Surgery was expedited to remove the affected testis. Histologic findings showed an inflamed epididymis with multiple microabscesses and global infarction of the testis. There was inflammation and thickening of mediumsized vessels within the spermatic cord, which was thought to be secondary to vascular occlusion (Figure 2, D and E). The patient was treated with 6 days of intravenous antibiotics. He made an uncomplicated recovery and remained well on follow-up. Discussion The cases above highlight the use of contrast-enhanced sonography for assessment of vascularity within the testis in the light of apparently normal testicular appearances on grayscale sonography. In both cases, changes in the epididymis were seen; however, the parenchyma of the testis 176
3 3201jumv-online.qxp:Layout 1 12/20/12 9:06 AM Page 177 did not show any abnormality to suggest ischemia. Color Doppler imaging identified a lack of flow within the testis, but contrast-enhanced sonography showed that the distinction of a lack of blood flow was much more obvious. In particular, contrast-enhanced sonography showed the complete absence of enhancing testicular parenchyma, indicating global testicular infarction. Imaging certainty with contrast-enhanced sonography allowed both patients A Figure 1. Case 1. A, Grayscale sonogram of the right testis showing uniform testicular reflectivity and a small surrounding hydrocele. Scrotal skin thickening (long arrow) is present, and there is thickening of the epididymis (short arrows). A septated hydrocele is present. B, Color Doppler image of the testis showing no depiction of a color signal within the entire testis. C, Contrast-enhanced image showing no vascular flow within the entire testis, confirming the infarction of the right testis. There is patchy enhancement of the epididymis with multiple foci of low reflectivity raising the possibility of small abscess formation. D, Epididymis with multiple microabscesses in the lumen, along with interstitial acute inflammation. The adjacent testis (bottom third) is infarcted (hematoxylin-eosin, original magnification 12.5). E. Infarcted testis showing intratubular and interstitial neutrophilic infiltrate and ghost germinal cells in the seminiferous tubules (hematoxylin-eosin, original magnification 100). B D C E 177
4 3201jumv-online.qxp:Layout 1 12/20/12 9:06 AM Page 178 to have a confident diagnosis and to rapidly undergo surgery, preventing further infection and relieving symptoms. The distinction between global and segmental infarction is important: the former specifies surgical man- agement to prevent further complications, whereas the latter normally can be managed conservatively with recovery of the nonaffected testis. Acute segmental infarction itself is uncommon; causes include inflammation, trauma, and A Figure 2. Case 2. A, Grayscale sonogram image of the left testis showing uniform testicular reflectivity and a sepated surrounding hydrocele. Scrotal skin thickening (long arrow) is present, and there is thickening of the epididymis (short arrows). B, Color Doppler image of the testis showing no depiction of a color signal within the entire testis. C, Contrast-enhanced image showing no vascular flow within the entire testis, confirming the infarction of the left testis. An abscess is shown in the epididymis (arrow), which is seen to retain vascular enhancement despite the global infarction of the testis. D, Epididymis with multiple luminal microabscesses and an edematous acutely inflamed interstitium. The adjacent testis (bottom right) is infarcted (hematoxylin-eosin, original magnification 12.5). E, Intermediate arteries of the spermatic cord showing wall neutrophilic infiltrate and luminal thrombosis (secondary vasculitis; hematoxylin-eosin, original magnification 100). B C 178 D E
5 torsion. 9 In a series of 24 patients with segmental infarction, 58% had underlying epididymo-orchitis. 2 Although infarction is frequently indistinguishable clinically from other causes of acute scrotal pain, sonography can establish the diagnosis. On grayscale imaging, a segmental infarct appears as a hypoechoic intratesticular lesion, which may be round or wedge shaped. The shape of the infarction is based on the etiology: segmental arterial infarction in the testis results in a wedge-shaped lesion with the apex pointing toward the rete testis; conversely, venous infarction results in rounded lesions and is thought more often to be secondary to epididymitis. 2 With a rounded expansive focal testicular lesion, grayscale imaging may suggest that an area of segmental infarction represents a testicular germ cell tumor. 10 Color Doppler imaging plays an important role in this situation to enable the differentiation of a vascular tumor from an avascular infarction. Recent studies have showed a role for contrast-enhanced sonography in the depiction of areas of nonvascularized tissue in the testes in both segmental infarction 2,3 and avascular epidermoid tumors. 11 Any increase in vascularity may indicate the presence of a vascular tumor. 12 The mechanism of segmental infarction may be testicular inflammation and edema, causing compression against the relatively rigid tunica albuginea, preventing expansion, and raising the intratesticular pressure. These effects would likely result in vascular compression of small peripheral intratesticular vessels, resulting in segmental infarction. Global testicular infarction is classically caused by arterial insufficiency from compromise of the testicular artery as a result of spermatic cord torsion. Global infarction is rare after epididymitis, when recurrent pain and infection after the acute event cause clinical uncertainty and require further imaging. In the cases described here, grayscale imaging showed no focal or global testicular abnormality, making interpretation difficult and with the color Doppler examination indicating poor or absent blood flow to the testis. The addition of power Doppler imaging may have helped but would still not have been conclusive; 3% of healthy patients had false-negative findings on power Doppler studies of the testis. 13 In comparison, contrast-enhanced sonography will unequivocally show the presence or absence of vascularity. The cause of global infarction in epididymitis is uncertain, but it may be due to mixed arterial and venous insufficiency. A postulated mechanism is edema of the epididymal head, causing compression of the testicular veins, which lie medially, before the formation of the pampiniform plexus, resulting in venous congestion and multiple thromboses. This condition has been previously documented on histologic examinations in a study of testicular infarction after epididymitis, in which 17 of 18 samples showed completely occluded epididymal veins within the spermatic cord. 14 The appearance of an arterial component is also suggested by the higher peak systolic velocity found in patients with epididymitis 15 than encountered in the normal testicular artery. 16 The relative sparing of the epididymis from infarction may be due to an independent blood supply from that of the testis; the epididymis is supplied by the cremasteric artery and deferential artery. This state suggests a degree of testicular arterial constriction within the spermatic cord affecting mainly the more vulnerable lowresistance flow in the artery to the testis, rather than the arteries to the epididymis. 16 As a result of these two mechanisms, it can be postulated that global testicular infarction is of a mixed arterial and venous etiology. In conclusion, contrast-enhanced sonography has proved to be useful in unequivocally confirming the absence of blood flow to the testis in global testicular infarction resulting from epididymitis. If there remains doubt when examining the testis in patients with epididymitis, the addition of contrast-enhanced sonography will increase operator confidence and aid in the diagnosis of this rare complication of global infarction, expediting correct clinical management. References 1. Chin SC, Wu CJ, Chen A, Hsiao HS. Segmental hemorrhagic infarction of testis associated with epididymitis. J Clin Ultrasound1998; 26: Bilagi P, Sriprasad S, Clarke JL, Sellars ME, Muir GH, Sidhu PS. Clinical and ultrasound features of segmental testicular infarction: six-year experience from a single centre. Eur Radiol 2007; 17: Bertolotto M, Derchi LE, Sidhu PS, et al. Acute segmental testicular infarction at contrast-enhanced ultrasound: early features and changes during follow-up. AJR Am J Roentgenol 2011; 196: Lung PF, Jaffer OS, Sellars ME, Sriprasad S, Kooiman GG, Sidhu PS. Contrast-enhanced ultrasound in the evaluation of focal testicular complications secondary to epidiymitis. AJR Am J Roentgenol 2012; 199:W345 W Owen ER, Kitson JL, Green B. Venous infarction of the testis secondary to acute epididymitis. Br J Urol 1990; 65: Rencken RK, DuPlessis DJ, DeHaas LS. Venous infarction of the testes a cause of non-response to conservative therapy in epididymo-orchitis: a case report. South Afr Med J 1990; 78: Bird K, Rosenfield AT. Testicular infarction secondary to acute inflammatory disease: demonstration by B-scan ultrasound. Radiology 1984; 152: Sue SR, Pelucio M, Gibbs M. Testicular infarction in a patient with epididymitis. Acad Emerg Med 1998; 5:
6 9. Fernandez-Perez GC, Tardaguila FM, Velasco M, et al. Radiologic findings of segmental testicular infarction. AJR Am J Roentgenol 2005; 184: Sriprasad SI, Kooiman GG, Muir GH, Sidhu PS. Acute segmental testicular infarction: differentiation from tumour using high frequency colour Doppler ultrasound. Br J Radiol 2001; 74: Patel K, Sellars ME, Clarke JL, Sidhu PS. Features of testicular epidermoid cysts on contrast-enhanced sonography and real-time tissue elastography. J Ultrasound Med 2012; 31: Valentino M, Bertolotto M, Derchi L, et al. Role of contrast enhanced ultrasound in acute scrotal diseases. Eur Radiol 2011; 21: Albrecht T, Lotzof K, Hussain HK, Shedden D, Cosgrove DO, de Bruyn R. Power Doppler US of the normal prepubertal testis: does it live up to its promises? Radiology 1997; 203: Hourihane DO. Infected infarcts of the testis: a study of 18 cases preceded by pyogenic epididymoorchitis. J Clin Pathol 1970; 23: Brown JM, Hammers LW, Barton JW, et al. Quantitative Doppler assessment of acute scrotal inflammation. Radiology 1995; 197: Aziz ZA, Satchithananda K, Khan M, Sidhu PS. High-frequency color Doppler ultrasonography of the spermatic cord arteries: resistive index variation in a cohort of 51 healthy men. J Ultrasound Med 2005; 24:
Vikram Dogra, M.D. Professor of Radiology, Urology & BME Department of Imaging Sciences University Of Rochester Medical Center
Ultrasound of the Scrotum Vikram Dogra, M.D. Professor of Radiology, Urology & BME Department of Imaging Sciences University Of Rochester Medical Center Etiologies of Acute Scrotal Pain Epididymitis/Orchitis
More informationTestis Elastography. Paul S. Sidhu. Professor of Imaging Sciences. King s College Hospital London
Testis Elastography Paul S. Sidhu Professor of Imaging Sciences King s College Hospital London Testicular Elastography Strain elastography Point Shear wave elastography 2D Shear wave elastography Multiparametric
More informationThe Acute Scrotum: Sonographic Findings
The Acute Scrotum: Sonographic Findings 가천의대길병원방사선과 양달모 Gachon Medical School Introduction Many diseases presenting as acute scrotal pain DDx is important for determining the appropriate treatment US with
More informationCOLOR DOPPLER ULTRASOUND IN EVALUATION OF SCROTAL LESIONS
COLOR DOPPLER ULTRASOUND IN EVALUATION OF SCROTAL LESIONS Desai Sanjay D Associate Professor, Department of Radiology, RCSM Govt. Medical College, Kolhapur. ABSTRACT: Color Doppler ultrasound is a non-invasive,
More informationAcute scrotum. Acute Epididymo-orchitis. Phyllis Yan, APDR (QEH)
Acute scrotum Acute Epididymo-orchitis Phyllis Yan, APDR (QEH) Conditions leading to acute pain Torsion Acute Epididymitis / Epididymoorchitis Scrotal trauma Inguinal hernias Testicular tumors Epididymitis/epididymo
More informationRole of Colour Doppler Ultrasonography in evaluation of scrotal pain and swelling
Original Research Article Role of Colour Doppler Ultrasonography in evaluation of scrotal pain and swelling Assistant Professor, Department of Radiodiagnosis, Government Medical College, Rajnandgaon Chattisghar,
More informationSonography of the scrotum: still the best!
Sonography of the scrotum: still the best! Poster No.: C-1110 Congress: ECR 2013 Type: Educational Exhibit Authors: W. Mnari, A. Zrig, M. Maatouk, B. Hmida, R. Salem, W. HarzallahHizem, M. Golli; Monastir/TN
More informationBilateral Segmental Testicular Infarction
Case Study TheScientificWorldJOURNAL (2007) 7, 779 783 TSW Urology ISSN 1537-744X; DOI 10.1100/tsw.2007.146 Bilateral Segmental Testicular Infarction Aaron Bayne 1, Brad Koslin 2, and Siamak Daneshmand
More informationDepartment of Medical Imaging, The Ottawa Hospital. Satheesh Krishna Sabarish Narayanasamy Wael Shabana Adnan Sheikh
Department of Medical Imaging, The Ottawa Hospital. Satheesh Krishna Sabarish Narayanasamy Wael Shabana Adnan Sheikh Nothing to disclose Common and unusual presentations and manifestations of testicular
More informationRole of US in acute scrotal pain
World J Urol (2011) 29:639 643 DOI 10.1007/s00345-011-0698-8 TOPIC PAPER Role of US in acute scrotal pain G. Liguori S. Bucci A. Zordani S. Benvenuto G. Ollandini G. Mazzon M. Bertolotto F. Cacciato S.
More informationTesticular ultrasound in acute scrotal pain - beyond testicular torsion
Testicular ultrasound in acute scrotal pain - beyond testicular torsion Poster No.: C-1284 Congress: ECR 2015 Type: Educational Exhibit Authors: I. Rolla, M. Nogueira, M. J. Aguiar, D. S. Garrido, J. A.
More informationTesticular Infarction and Rupture After Blunt Trauma Use of Diagnostic Ultrasound
Short Review TheScientificWorldJOURNAL (2004) 4, 437 441 ISSN 1537-744X; DOI 10.1100/tsw.2004.101 Testicular Infarction and Rupture After Blunt Trauma Use of Diagnostic Ultrasound Alistair Pace 1, * and
More informationContrast enhanced harmonic ultrasonography for the evaluation of acute scrotal pathology. Pictorial essay.
Pictorial essay Med Ultrason 2016, Vol. 18, no. 1, 110-115 DOI: 10.11152/mu.2013.2066.181.esy Contrast enhanced harmonic ultrasonography for the evaluation of acute scrotal pathology. Pictorial essay.
More informationDr Prashant Jain. Sr. Consultant, Pediatric surgery BLK Superspeciality Hospital
Dr Prashant Jain Sr. Consultant, Pediatric surgery BLK Superspeciality Hospital Acute Scrotum Presentation 0 Pain in scrotal area 0 Scrotal swelling 0 Scrotal redness take him to nearby emergency... Acute
More informationRole of ultrasound and color Doppler in the evaluation of acute scrotal pain
Bang Med J Khulna 2017; 50 : 26-30 ORIGINAL ARTICLE Abstract Role of ultrasound and color Doppler in the evaluation of acute scrotal pain G Salahuddin 1, SMZ Nayeem 2, SM Hossain 3, S Parvin 4, MM Hossain
More informationDifferential Diagnosis of Focal Epididymal Lesions With Gray Scale Sonographic, Color Doppler Sonographic, and Clinical Features
Article Differential Diagnosis of Focal Epididymal Lesions With Gray Scale Sonographic, Color Doppler Sonographic, and Clinical Features Dal Mo Yang, MD, Sun Ho Kim, MD, Ha Na Kim, MD, Jee Hee Kang, MD,
More informationUS features of scrotal disorders: A pictorial essay
US features of scrotal disorders: A pictorial essay Poster No.: C-0463 Congress: ECR 2014 Type: Educational Exhibit Authors: J. SAAD, F. Marrakchi ; nejran, sa/sa, Monastir/TN Keywords: Genital / Reproductive
More informationThe role of ultrasonography with colour Doppler in the acute scrotum
The role of ultrasonography with colour Doppler in the acute scrotum Poster No.: C-1509 Congress: ECR 2016 Type: Educational Exhibit Authors: M. S. R. O. Faustino, A. L. Amado Costa, J. J. B. Leitão, I.
More informationThe Sonographic Pattern of Diseases Presenting with Scrotal Pain at Mulago Hospital, Kampala, Uganda
http://www.bioline.org.br/js 68 The Sonographic Pattern of Diseases Presenting with Scrotal Pain at Mulago Hospital, Kampala, Uganda J. Opio 1, R.K. Byanyima 2, E. Kiguli-Malwadde 2, S. Kaggwa 3, M. Kawooya
More informationUltrasonography of Acute Scrotum
Ultrasonography of Acute Scrotum Poster No.: C-0331 Congress: ECR 2012 Type: Educational Exhibit Authors: O. Nikolic, T. Mrdanin, M. Basta Nikolic, S. Stojanovic, K. 1 1 1 1 1 1 2 1 1 Petrovic, V. Vucaj
More informationVI E Article Clinics in diagnostic imaging (114)
264 Medical Education Singapore Med.1 2007, 48 (3) : VI E Article Clinics in diagnostic imaging (114) Muttarak M, Thinyu S, Lojanapiwat B Fig. I Clinical photograph of the scrotum. T t o T Fig. 2a Longitudinal
More informationAlex Lam, HMS III. September The Acute Scrotum. Alex Lam, Harvard Medical School Year III Gillian Lieberman, MD. Gillian Lieberman, MD
September 2002 The Acute Scrotum Alex Lam, Harvard Medical School Year III DDx: : Acute Scrotal Pain & Enlargement PAIN Inflammatory disorder Testicular torsion Testicular infarction Testicular abscess
More informationScrotum Kacey Morrison Amanda Baxter Sabrina Tucker July 18, 2006 SCROTUM
Scrotum Kacey Morrison Amanda Baxter Sabrina Tucker July 18, 2006 SCROTUM 1) Other Names: Scrotum None Testicles Testes (Curry Tempkin, p. 236, 2/3/2) Ductus deferens spermatic cord (Tempkin, p. 279, Anatomy
More informationpreceded by pyogenic epididymoorchitis
J. clin. Path., 1970, 23, 668-675 Infected infarcts of the testis: A study of 18 cases preceded by pyogenic epididymoorchitis D. O'B. HOURIHANE From the Central Histopathology Laboratory of the Federated
More informationRole of ultrasound and colour doppler in assessment of adult scrotal pathologies
Original Research Article Role of ultrasound and colour doppler in assessment of adult scrotal pathologies Ajay Vare 1, Dayanand Kawade 2*, Varsha Rote Kakinalkar 3, Prashant Titare 4, Samruddhi Sonawane
More informationSonography of the Scrotum: Case-Based Review
AJR Integrative Imaging LIFELONG LEARNING FOR RADIOLOGY Sonography of the Scrotum: Case-Based Review Joseph W. Stengel 1,2 and Erick M. Remer 1 ABSTRACT Objective We discuss five scenarios in which sonography
More informationScrotal pain and Swelling
Scrotal pain and Swelling Color index : Important Further explanation Done By: Nada Alamri Editing link Acute Scrotal Pain DDx: 1) Testicular torsion : Twisting and strangulation of the testicle on the
More informationPrevalence of testicular microlithiasis in boys aged 0 to 19 years referred for scrotal pathology
Chapter 2.3 Prevalence of testicular microlithiasis in boys aged 0 to 19 years referred for scrotal pathology J Goede HA Hofman AM Wagenvoort FH Pierik WWM Hack Nephro-Urol Mon, in press 59 Chapter 2.3
More informationRole of high frequency ultrasound and color Doppler examination in scrotal lesions
Original article: Role of high frequency ultrasound and color Doppler examination in scrotal lesions 1Sanjeev Sharma, 2 Monika Jindal, 3 Sakshi Sharma, 4 Rekha Goyal, 5 Subhash Goyal 1Assistant Professor
More informationEvaluation of Testicular Disease using Ultrasound
Evaluation of Testicular Disease using Ultrasound Abdullah Hamdan 1, Alsafi Abdulla 2, Mohamed Yousef 3 1 Radiologic Technology Department, College of Applied Medical Science, Qassim University, Buraduh,
More informationAcute Groin Pain Following Trauma
Lehigh Valley Health Network LVHN Scholarly Works Department of Family Medicine Acute Groin Pain Following Trauma Victoria Chen MD Lehigh Valley Health Network, victoria.chen@lvhn.org Follow this and additional
More informationRADIONUCLIDE STUDIES IN THE MANAGEMENT OF PAINFUL TESTICULAR PATHOLOGY
RADIONUCLIDE STUDIES IN THE MANAGEMENT OF PAINFUL TESTICULAR PATHOLOGY Isabel Roca Vall d'hebron Hospital General Servei de Medicina Nuclear TESTICULAR SCINTIGRAPHY ACUTE TESTICULAR PAIN Differential Diagnosis
More informationRole of Spectral Doppler Sonography in the Evaluation of Partial Testicular Torsion
ase Series Role of Spectral Doppler Sonography in the Evaluation of Partial Testicular Torsion Scott assar, MD, Shweta hatt, MD, Harriet J. Paltiel, MD, Vikram S. Dogra, MD Objective. The purpose of this
More informationCase Report Testicular Arteriovenous Malformation: Gray-Scale and Color Doppler Ultrasonography Features
Volume 2011, Article ID 876206, 4 pages doi:10.11/2011/876206 Case Report Testicular Arteriovenous Malformation: Gray-Scale and Color Doppler Ultrasonography Features Fatih Gulsen, 1 Ismail Mihmanli, 1
More informationDifferential Diagnosis of The Acute Scrotum in The Pediatric Population.
Differential Diagnosis of The Acute Scrotum in The Pediatric Population. Poster No.: C-1736 Congress: ECR 2013 Type: Educational Exhibit Authors: D. M. Castaño Palacios, J. C. Rayón-Aledo, I. Solis Muniz,
More informationGenitourinary Radiology In-Training Test Questions for Diagnostic Radiology Residents
Genitourinary Radiology In-Training Test Questions for Diagnostic Radiology Residents March, 2013 Sponsored by: Commission on Education Committee on Residency Training in Diagnostic Radiology 2013 by American
More informationSonography of the Pediatric Scrotum: Emphasis on the Ts Torsion, Trauma, and Tumors
Pediatric Imaging Clinical Perspective Sung et al. Ultrasound of Pediatric Scrotum Pediatric Imaging Clinical Perspective Downloaded from www.ajronline.org by 37.44.201.148 on 01/21/18 from IP address
More informationBENIGN & MALIGNANT TESTIS DISEASES. Gary J. Faerber, M.D. Associate Professor, Dept of Urology March 2009 OBJECTIVES
BENIGN & MALIGNANT TESTIS DISEASES Gary J. Faerber, M.D. Associate Professor, Dept of Urology March 2009 OBJECTIVES 1. Become familiar with the scrotal contents and their anatomical relationship with each
More informationMiss Rashmi Singh Consultant urological Surgeon. Men s Health Seminar Parkside Hospital November 2016
Miss Rashmi Singh Consultant urological Surgeon Men s Health Seminar Parkside Hospital November 2016 Hernia Hydrocele Varicocele Infections Epididymal cyst Testicular Ca Miscellaneous Phimosis Paraphimosis
More informationOriginal Research Article
EVALUATION OF SCROTAL PATHOLOGY BY HIGH RESOLUTION ULTRASOUND AND COLOUR DOPPLER Pintu Biswas 1, Asim De 2 1Senior Resident, Department of Radiodiagnosis, Agartala Government Medical College and G. B.
More informationEmergent Pediatric Ultrasound. Katharine Dennis, RDMS/RVT Tiffany Schultz, RDMS UNC Health Care Dept of General Ultrasound
Emergent Pediatric Ultrasound Katharine Dennis, RDMS/RVT Tiffany Schultz, RDMS UNC Health Care Dept of General Ultrasound Introduction Learning Objectives Review common pediatric emergent ultrasound exams
More informationCase 5385 Tubular ectasia of the rete testis: a benign testicular entity diagnosed on imaging
Case 5385 Tubular ectasia of the rete testis: a benign testicular entity diagnosed on imaging A. C. Tsili 1, C. Tsampoulas 1, D. Giannakis 2, A. Chaidou 1, N. Sofikitis 2, S. C. Efremidis 1 1 Department
More informationThe acute scrotum the two most difficult US problems. Simon Freeman Derriford Hospital, Plymouth. UK
The acute scrotum the two most difficult US problems Simon Freeman Derriford Hospital, Plymouth. UK simonfreeman@nhs.net The Acute Scrotum 1. Ischaemia 1. Spermatic cord torsion 2. Torsion of a testicular
More informationAcute Segmental Testicular Infarction at Contrast-Enhanced Ultrasound: Early Features and Changes During Follow-Up
Genitourinary Imaging Original Research Bertolotto et al. Ultrasound of Testicular Infarction Genitourinary Imaging Original Research Michele Bertolotto 1 Lorenzo E. Derchi 2 Paul S. Sidhu 3 Giovanni Serafini
More informationINFECTIOUS SCROTAL CONDITIONS
ATHENS 4-6 October 2018 European Society of Urogenital Radiology INFECTIOUS SCROTAL CONDITIONS Mustafa SECIL, MD Professor of Radiology, Dokuz Eylul University Faculty of Medicine Department of Radiology
More informationScrotal emergencies Subramaniyan Ramanathan
Scrotal emergencies Subramaniyan Ramanathan Weill Cornell Medicine, New York (Qatar campus) Hamad medical corporation, Doha, Qatar Disclosure Statement I have no relationships with commercial interests
More informationThe clinical sign of pleurisy is characterized by a
Contrast-Enhanced Sonography for Differential Diagnosis of Pleurisy and Focal Pleural Lesions of Unknown Cause* Christian Görg, MD; Tillmann Bert, MD; and Konrad Görg, MD Background: Ultrasound enables
More informationDiagnosis and Management of the Acute Scrotum. AUA update series 2016 volume 35. By Anas Hindawi,Urology Resident Moderated by Dr.
Diagnosis and Management of the Acute Scrotum AUA update series 2016 volume 35 By Anas Hindawi,Urology Resident Moderated by Dr. Khalid Al Sayyid Introduction The acute onset of pain,tenderness or swelling
More informationAmerican College of Radiology ACR Appropriateness Criteria
American College of Radiology ACR Appropriateness Criteria Date of origin: 1995 Last review date: 2014 Clinical Condition: Variant 1: Acute Onset of Scrotal Pain Without Trauma, Without Antecedent Mass
More informationScrotal Swellings. Dr John Nash GPwSI Urology
Scrotal Swellings Dr John Nash GPwSI Urology Mode of Presentation Acute Pain Elective Non-acute Pain Acute Painful Presentation Testicular Torsion Torsion of Testicular Appendage ( Hydatid of Morgagni)
More informationManagement of the Acute Scrotum in a District General Hospital: 10-Year Experience
Research Article TheScientificWorldJOURNAL (2009) 9, 281 286 TSW Urology ISSN 1537-744X; DOI 10.1100/tsw.2009.37 Management of the Acute Scrotum in a District General Hospital: 10-Year Experience Lukas
More informationImportance of the testicular torsion in the male infertility. A. Rusz, Gy. Papp Military Hospital-State Health Centre (ÁEK) EAA Centre
Importance of the testicular torsion in the male infertility A. Rusz, Gy. Papp Military Hospital-State Health Centre (ÁEK) EAA Centre Budapest, Hungary Acute scrotum Torsion of the testis Torsion of the
More informationSegmental testicular infarction: role of imaging
Segmental testicular infarction: role of imaging Poster No.: C-0583 Congress: ECR 2013 Type: Scientific Exhibit Authors: F. Albarello, S. Zago, P. Campioni, M. Giganti, G. Parenti ; 1 1 2 1 1 2 2 Ferrara/IT,
More information*OPERATIVE PROCEDURE. Serum tumour markers within normal limits S1.04 PRINCIPAL CLINICIAN
Neoplasia of the Testis - Orchidectomy Histopathology Reporting Proforma Includes the International Collaboration on Cancer reporting dataset denoted by * Family name Given name(s) Date of birth Indigenous
More informationMATERIALS AND METHODS
Imaging Features of Gray-Scale and Contrast-Enhanced Color Doppler US for the Differentiation of Transient Renal Arterial Ischemia and Arterial Infarction Byung Kwan Park, MD 1, 2 Seung Hyup Kim, MD 1
More informationSeeing the Unseen Clinical advances and future directions of SMI
Seeing the Unseen Clinical advances and future directions of SMI Jiro Hata, M.D., Ph. D. Professor Department of Endoscopy and Ultrasound Kawasaki Medical School Okayama, Japan Introduction Superb Micro-vascular
More informationESUR SCROTAL AND PENILE IMAGING WORKING GROUP MULTIMODALITY IMAGING APPROACH TO SCROTAL AND PENILE PATHOLOGIES 2ND ESUR TEACHING COURSE
ESUR SCROTAL AND PENILE IMAGING WORKING GROUP MULTIMODALITY IMAGING APPROACH TO SCROTAL AND PENILE PATHOLOGIES 2ND ESUR TEACHING COURSE NORMAL ANATOMY OF THE SCROTUM MICHAEL NOMIKOS M.D. F.E.B.U. UROLOGICAL
More informationUltrasound of malignant testicular lesions. Arne Hørlyck Department of Radiology Aarhus University Hospital, Skejby
Ultrasound of malignant testicular lesions Arne Hørlyck Department of Radiology Aarhus University Hospital, Skejby Testis Ultrasound is fantastic!! Scrotum Extratesticular mass: Benign Intratesticular
More informationPainless palpable scrotal mass
Clinical Case - Test Yourself Urogenital Painless palpable scrotal mass Charis Anastasiadis, Georgia Kyriakopoulou, Charikleia Triantopoulou Radiology Department, Konstantopoulio General Hospital of Nea
More informationSeeing the Unseen Clinical advances and future directions of SMI
M edical R eview Seeing the Unseen Clinical advances and future directions of SMI Dr. Jiro Hata, M.D., Ph. D. Department of Endoscopy and Ultrasound, Kawasaki Medical School, Okayama, Japan M edical R
More informationSonographic Appearance of the Epididymis in Pediatric Testicular Torsion
Nussbaum Blask and Rushton Sonography of Testicular Torsion in Pediatric Patients Pediatric Imaging Original Research A C D E M N E U T R Y L I A M C A I G O F I N G Anna R. Nussbaum Blask 1 H. Gil Rushton
More informationVaricoceles : co-relation of clinical examination with Color Doppler Sonograpghy at a tertiary care hospital
Original article: Varicoceles : co-relation of clinical examination with Color Doppler Sonograpghy at a tertiary care hospital 1Dr. Neeraj Prajapati, 2 Dr. S.K.Ratogi, 3 Dr. Vijay Kulshrestha, 4 Dr. Abhinav
More informationWe are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors
We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists 3,700 108,500 1.7 M Open access books available International authors and editors Downloads Our
More informationBilateral Epididymal Cyst in 65 Years Old Man A Case Report Thorat Nilesh Suresh 1 *, Raut Subhash Y 2 and Kedar Nita M 3
Int J Ayu Pharm Chem CASE STUDY www.ijapc.com e-issn 2350-0204 Bilateral Epididymal Cyst in 65 Years Old Man A Case Report Thorat Nilesh Suresh 1 *, Raut Subhash Y 2 and Kedar Nita M 3 1-3 Shalyatantra
More informationExtratesticular Extension of Germ Cell Tumors Preferentially Occurs at the Hilum
Anatomic Pathology / EXTRATESTICULAR EXTENSION OF GERM CELL TUMORS Extratesticular Extension of Germ Cell Tumors Preferentially Occurs at the Hilum Sarah M. Dry, MD, and Andrew A. Renshaw, MD Key Words:
More informationTitleUltrasonic evaluation of scrotal sw. Author(s) MISAKI, Toshimitsu; HISAZUMI, Haruo. Citation 泌尿器科紀要 (1985), 31(7):
TitleUltrasonic evaluation of scrotal sw Author(s) MISAKI, Toshimitsu; HISAZUMI, Haruo Citation 泌尿器科紀要 (1985), 31(7): 1151-1158 Issue Date 1985-07 URL http://hdl.handle.net/2433/118548 Right Type Departmental
More informationProfile of Acute Epididymo-Orchitis Patients in Arifin Achmad Regional General Hospital Riau Province, Indonesia
ORIGINAL ARTICLE Profile of Acute Epididymo-Orchitis Patients in Arifin Achmad Regional General Hospital Riau Province, Indonesia Zuhirman Zamzami 1 Author s Affiliations: 1 Urology Division, Surgery Department,
More informationEssentials of Clinical MR, 2 nd edition. 73. Urinary Bladder and Male Pelvis
73. Urinary Bladder and Male Pelvis Urinary bladder carcinoma is best locally staged with MRI. It is important however to note that a thickened wall (> 5 mm) is a non-specific finding seen in an underfilled
More informationColour Doppler and duplex ultrasound assessment of Peyronie's disease in impotent men
1993, The British Journal of Radiology, 66, 398-402 Colour Doppler and duplex ultrasound assessment of Peyronie's disease in impotent men 1 Z AMIN, MRCP, 1 U PATEL, MRCP, FRCR, 1 E P FRIEDMAN, MRCP, 2
More informationGuidelines for the Management of Acute Scrotal Pain in Children (V 1.0)
Guidelines for the Management of Acute Scrotal Pain in Children (V 1.0) Clinical Director Signed Name... Mr C. Hendrickse.. Date 14/10/2011.. Meta Data Guideline Title: Guidelines for the Management of
More informationLooking for changes in testicular echotexture: review of pathology with diffuse alteration of testicular echogenicity.
Looking for changes in testicular echotexture: review of pathology with diffuse alteration of testicular echogenicity. Poster No.: C-1884 Congress: ECR 2015 Type: Educational Exhibit Authors: M. Atencia
More informationSpermatogenesis Following Experimental Testicular Ischemia
Spermatogenesis Following Experimental Testicular Ischemia Frank Hinman, Jr, MD, and Gilbert I Smith, MD REGENERATION of the spermatogenic elements of the testis after depression by testosterone and by
More informationUltrasonography of intratesticular lesions: its role in
The Ulster Medical Journal, Volume 68, No. 2, pp. 54-8, November 1999. Ultrasonography of intratesticular lesions: its role in clinical management P T Kennedy, J M Elliott, P F Rice, B E Kelly Accepted
More informationUS of Acute Scrotal Trauma: Optimal Technique, Imaging Findings, and Management 1
Note: This copy is for your personal non-commercial use only. To order presentation-ready copies for distribution to your colleagues or clients, contact us at www.rsna.org/rsnarights. EDUCATION EXHIBIT
More informationA CLINICOPATHOLOGIC STUDY OF TUBERCULOUS EPIDIDYMO-ORCHITIS IN THAILAND
Tuberculous Epididymo-Orchitis in Thailand A CLINICOPATHOLOGIC STUDY OF TUBERCULOUS EPIDIDYMO-ORCHITIS IN THAILAND Ulan Suankwan 1, Noppadol Larbcharoensub 1, Wit Viseshsindh 2, Cholatip Wiratkapun 3 and
More informationRole of Ultrasound and Colour Doppler in Scrotal Pain
Role of Ultrasound and Colour Doppler in Scrotal Pain Dr. Vikram Patil 1, Dr.SM Chandrashekar Shetty 2 1 Radiologist, Department of Radiology, JSS Medical College, JSS University, Mysuru, Karnataka, India
More informationThe role for contrast-enhanced ultrasonography outside of focal liver lesions
The role for contrast-enhanced ultrasonography outside of focal liver lesions Paul S. Sidhu King s College Hospital, London, UK Introduction Contrast-enhanced ultrasonography (US) of focal liver lesions
More informationLocal Anesthesia during Transrectal Prostate Biopsy
Local Anesthesia during Transrectal Prostate Biopsy Awad A1-Kaabneh, MD*, Tareq Bisheh, MD ABSTRACT Objectives: To determine the effectiveness of the longer acting agent bupivacaine for periprostatic anesthesia
More informationGood Morning! March 23, 2015
Good Morning! March 23, 2015 Prep Question You are caring for an 8-year-old girl who was involved in a motor vehiclepedestrian crash. Despite maximal medical and surgical therapy, she developed intractable
More informationExercise. Discharge Summary
Exercise Discharge Summary A 32-year-old Brazilian male presented with a 6 month history of right-sided scrotal swelling. Backache was present for 2 months and a history of right epididymitis was present
More informationSurgery Illustrated Surgical Atlas Inguinal orchidectomy for testicular cancer
Surgery Illustrated Focus on Details SURGERY ILLUSTRATED SURGICAL ATLASPIZZOCARO and GUARNERI PIZZOCARO and GUARNERI BJUI BJU INTERNATIONAL Surgery Illustrated Surgical Atlas Inguinal orchidectomy for
More informationIntraparenchymatous adenomatoid tumor dependent on the rete testis: A case report and review of literature
Intraparenchymatous adenomatoid tumor dependent on the rete testis: A case report and review of literature A. Jiménez Pacheco, J. L. Martínez Torres, F. Valle Díaz de la Guardia, M. A. Arrabal Polo, and
More informationTitleBenign cystic lesion of the tunica Author(s) Tanaka, Kazushi; Kamidono, Sadao; Y Keiichi Citation 泌尿器科紀要 (2004), 50(1): 45-48 Issue Date 2004-01 URL http://hdl.handle.net/2433/113289 Right Type Departmental
More informationSonographic Findings of Adductor Insertion Avulsion Syndrome With Magnetic Resonance Imaging Correlation
Case Report Sonographic Findings of Adductor Insertion Avulsion Syndrome With Magnetic Resonance Imaging Correlation Jennifer S. Weaver, MD, Jon A. Jacobson, MD, David A. Jamadar, MBBS, Curtis W. Hayes,
More informationBrain Atrophy. Brain Atrophy
Aging Central Nervous System Processes Age related brain atrophy Non-age related brain atrophy Cerebrovascular disease Cerebral infarction Hypertensive hemorrhage Carotid artery stenosis and occlusion
More informationSonographic Whirlpool Sign in Ovarian Torsion
Technical dvance Sonographic Whirlpool Sign in Ovarian Torsion S. oopathy Vijayaraghavan, MD, DMRD Objective. To describe an additional maneuver during sonography for ovarian torsion and to assess its
More informationCase Scenario 1 Discharge Summary Pathology Report Final Diagnosis: Oncology Consult
Case Scenario 1 Discharge Summary A 31-year-old Brazilian male presented with a 6 month history of right-sided scrotal swelling. Backache was present for 2 months and a history of right epididymitis was
More informationDr. Syah Mirsya Warli, SpU Dr. Bungaran Sihombing,SpU Div. of Urology, Surgery Dept. Medical Faculty, University of Sumatera Utara
Emergency Room Urology Dr. Syah Mirsya Warli, SpU Dr. Bungaran Sihombing,SpU Div. of Urology, Surgery Dept. Medical Faculty, University of Sumatera Utara Ref : Clinical Manual of Urology, (Philip M. Hanno
More informationof segmental testicular infarction an infrequent testicular disorder rarely described in the radiologic
Genitourinary Imaging Fernández-Pérez et al. Radiology of Testicular Infarction Gabriel C. Fernández-Pérez 1 Francisco M. Tardáguila 1 María Velasco 1 Celso Rivas 1 John Dos Santos 2 Javier Cambronero
More informationInternational Journal of Case Studies in Clinical Research
Case Report International Journal of Case Studies in Clinical Research Open Access Acute Vasitis Presenting as an Inguinoscrotal Swelling: A Diagnostic Dilemma 1 Akanji Akinwunmi O, 2 Akinola Oluwaseun
More informationJournal of Medical Science & Technology
Review Article Journal of Medical Science & Technology Malakoplakia of testis and epididymis: A Review of the Literature Anthony Kodzo-Grey Venyo 1 * Open Access 1 North Manchester General Hospital, Department
More informationMultifocal testicular capillary hemangioma
www.edoriumjournals.com case Report open ACCESS Multifocal testicular capillary hemangioma Shikha Singhal, Waseem Akhtar, Mabel Das Thyveetil ABSTRACT Introduction: Capillary hemangioma of testis is extremely
More informationFor more information about how to cite these materials visit
Author(s): Gary Faerber, M.D., 2011 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike 3.0 License: http://creativecommons.org/licenses/by-sa/3.0/
More informationFollow up of Testicular Microlithiasis
ATHENS 4-6 October 2018 European Society of Urogenital Radiology Follow up of Testicular Microlithiasis ESUR Scrotal Imaging Group Jonathan Richenberg 2nd ESUR Teaching Course Multimodality Imaging Approach
More informationTesticular Torsion: A Perspective from the Middle East
Original Paper Med Princ Pract 2004;13:255 259 DOI: 10.1159/000079523 Received: June 22, 2003 Revised: October 6, 2003 Testicular Torsion: A Perspective from the Middle East A.A. Al-Hunayan A.M. Hanafy
More informationInflammation of the Gonad in Prepubertal Healthy Children. Epidemiology, Etiology, and Management
Review Article TheScientificWorldJOURNAL (2006) 6, 1081 1085 ISSN 1537-744X; DOI 10.1100/tsw.2006.200 Inflammation of the Gonad in Prepubertal Healthy Children. Epidemiology, Etiology, and Management Sarel
More informationADVERSE EFFECTS OF VASECTOMY: SPERM GRANULOMA OF EPIDIDYMIDES V. P. DIXIT
ADVERSE EFFECTS OF VASECTOMY: SPERM GRANULOMA OF EPIDIDYMIDES V. P. DIXIT Reproduct ion Physiology Section, Department of Zoology, University of Rajasthan, Jaipur-302004 Summary: Rats and mice were vasectomized
More informationCase Scenario 1 Discharge Summary Pathology Report Final Diagnosis: Oncology Consult
Case Scenario 1 Discharge Summary A 31-year-old Brazilian male presented with a 6 month history of right-sided scrotal swelling. Backache was present for 2 months and a history of right epididymitis was
More informationCase 3853 Colour-coded duplex and contrast medium enhanced ultrasonography in deep venous thrombosis in emergency patients
Case 3853 Colour-coded duplex and contrast medium enhanced ultrasonography in deep venous thrombosis in emergency patients A.Kotis Radiologist M.D, L.Guindaglia Radiologist M.D. Radiology Department General
More informationApplied scrotal ultrasound anatomy and pathology:a pictorial review
Applied scrotal ultrasound anatomy and pathology:a pictorial review Poster No.: C-1166 Congress: ECR 2014 Type: Educational Exhibit Authors: S. Santos Magadán, D. Gómez-Santos, J. García-Yavar, 1 1 2 1
More information