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PubMedDate not supplied

Cystic lesions of the orbit.

BACKGROUND/AIMS: Cystic lesions of the orbit constitute a group of lesions with diverse clinical findings, histopathologic features and pathogenesis. METHODS: We reviewed the histopathologic and clinical records on 128 orbital cystic lesions diagnosed during a 32-year period from 1963 to 1995. RESULTS: Of the 128 orbital cystic lesions, dermoid cysts were the most frequent (38 cases, 29.7%). The other lesions, in decreasing order of frequency, were hydatid cysts (33 cases, 25.8%), mucoceles (31 cases, 24.2%), pyoceles (10 cases, 7.8%), meningoencephaloceles (9 cases, 7.0%), epidermal inclusion cysts (4 cases, 3.1%), hematoceles (2 cases, 1.6%) and teratoma (one case, 0.8%). CONCLUSIONS: Our review showed that 64.1% of patients with cystic lesions were aged 18 years or less. With the exception of mucopyoceles, all the other cystic lesions were more frequent in pediatric patients. Cystic lesions behaved clinically as benign lesions. At a mean follow-up of 6.7 years we did not observe development of malignancy in any of the cystic tumor cases though variable degrees of vision loss developed due to factors such as optic nerve compression, ocular damage and amblyopia.

Adolescent↗

PubMed2001

Imaging of the acute scrotum.

The scrotum is a superficial structure and clinical examination is frequently not enough for making a specific diagnosis. In acute scrotal pain US can confirm the presumptive clinical diagnosis and provide additional relevant information. In testicular torsion, color-Doppler imaging has a central role since it has become possible to identify it at early stage by showing absence of perfusion in the affected testis before any gray-scale abnormality. Scintigraphy remains a satisfactory alternative in evaluating testicular torsion and should be used when color Doppler is inadequate, raising doubts about the suspected torsion. Diagnosis of torsion of testicular appendages is particularly difficult. Ischemic infarction shows a characteristic pattern at gray-scale and color Doppler imaging, whereas hemorrhagic ischemia may require MRI. Inflammatory diseases of the scrotum can be easily investigated by echo color Doppler and conventional radiography, and CT can be particularly useful in the detection of gas bubbles. In scrotal trauma, scrotal hematoma, hematocele, intratesticular hematoma, and testicular rupture can be identified using gray-scale US with very good reliability. Magnetic resonance imaging is indicated when a small tear of tunica albuginea is suspected but not visualized on US.

Acute Disease↗

PubMed1981

Traumatic torsion of testicle.

Most genitourinary surgeons advocate early exploration of all enlarging scrotal masses, hematoceles, or suspected testicular ruptures resulting from trauma. Two cases of torsion of the testicle following severe blunt testicular trauma are presented. It is suggested that another indication for prompt surgical exploration of a scrotal mass after severe blunt testicular trauma is to help establish an early diagnosis of torsion of the testicle. This approach affords an opportunity for appropriate therapy and testicular salvage.

Adolescent↗

PubMed1989

Blunt scrotal trauma: emergency department evaluation and management.

Blunt scrotal trauma may result in a variety of injuries, including testicular rupture, torsion, dislocation, hematoma, or contusion, as well as epididymal, scrotal, and urethral injuries. Testicular rupture occurs in 50% of patients with traumatic hematocele, and is probably frequently misdiagnosed. If not aggressively diagnosed and surgically repaired, testicular rupture may lead to testicular atrophy and loss. Traumatic testicular torsion must also be diagnosed early to preclude testicular loss. Testicular scan, when rapidly available, is indicated in any case of suspected traumatic torsion. If testicular scanning is unavailable or equivocal, surgical exploration is indicated. Once torsion is ruled out, ultrasound is a useful diagnostic technique in acute scrotal trauma to differentiate those scrotal and testicular injuries requiring surgical intervention.

Child↗

PubMed2006

[Scrotal trauma: management strategy].

Scrotal traumas are rare. Most are blunt traumas caused by a direct blow on the scrotum. The testicle is projected against the pubic arch. Early surgical investigation has considerably improved the prognosis of testicular trauma, and reduced orchidectomy rate. ULtrasonography has also improved the management of scrotal trauma. But there is a controversy about accuracy of ultrasonography in predicting presence or absence of testicular disruption. ULtrasonography should not challenge the dogma regarding systematic surgical investigation of hematocele and enlarged scrotum. Long term outcomes (testicular atrophy, infertility) may be more frequent as previously thought and should be detected.

Decision Trees↗

PubMed2006

Does color Doppler sonography improve the clinical assessment of patients with acute scrotum?

INTRODUCTION AND OBJECTIVES: Our experience concerning the use of color Doppler sonography (CDS) in the differential diagnosis of acute scrotum is reported. MATERIAL AND METHODS: From July 2000 to July 2005, 155 patients (median 17.2 years) were admitted with a diagnosis of acute scrotum (unilateral in 150 cases, bilateral in 5). Along with a careful anamnesis and the physical exam, all patients underwent a CDS study of the scrotal content using a sonograph GE Logiq 500 with a multifrequency (7.5-10 MHz) linear probe Small Part. The following CDS parameters were evaluated: intensity of the color-power signal on the testicular parenchyma and on the epididymis; systolic peak velocity (SPV) and telediastolic velocity (TDV) in correspondence of the gonadal hilum. Ultrasound and flowmetry parameters registered on the painful testis were compared with those registered on the healthy controlateral testis. The reduction/absence versus the increase of color-power signal in the parenchyma and the reduction/absence versus the increase of SPV and TDV in the centripetal intratesticular arteries were considered presumptive of testicular torsion versus orchiepididymitis. RESULTS: The results only refer to the 150 patients (300 testis) with acute monolateral scrotum. The clinical picture and the physical exam suggested a torsion of the spermatic cord in 40 cases, a spontaneous de-torsion in 5, an orchiepididymitis in 80, a blunt scrotal trauma in 15, a bulky epididymal cyst or a hydrocele in 4 and a testicular pain of unknown etiology in the remaining 6 cases. Standard US was pathological in 95 patients (63.3%); CDS was pathologic in 70 patients and in 42 of them suggested a testicular torsion. Fifty-three patients underwent surgical exploration: among 42 patients with a presumptive diagnosis of testicular torsion, the diagnosis was confirmed in 22 cases, no anomaly was found in 16 cases and in 4 patients a torsion of testicular appendix was found. The rupture of the tunica albuginea was present in six out of seven patients submitted to surgical exploration for previous blunt trauma and the sonographic diagnosis of hematocele was documented in all cases. The single false-negative diagnosis of testicular torsion in CDS occurred in an 18-month-old child. In presence of funicular torsion, the sensitivity and specificity of physical exam and CDS were 100% versus 95.7% and 86.5% versus 85.3%, respectively; sensitivity and specificity of SPV, TDV and color-Doppler signal on the testis were 100% and 94.8% versus 100% and 90.1% versus 95.7% and 90.8%. In the pre-operative assessment of scrotal trauma, the B-mode US showed a sensitivity and specificity of 100% and 90%, respectively; the color Doppler analysis has not supplied with additional elements for planning a surgical exploration. In presence of orchiepididymitis, the sensitivity and specificity of the physical exam in association to CDS was equal to 100%. In all patients with torsion of the testicular appendix, physical exam and CDS parameters were within normal limits. DISCUSSION AND CONCLUSIONS: In our experience CDS is an indispensable imaging modality for the clinical assessment of patients with acute scrotum; however, the informations it can afford are operator-dependent and have to be supported by the history and physical exam of the patient. CDS findings constitute probably an important medico-legal support when the necessity of surgical exploration is excluded; anyway, in presence of a clinical suspicion of testicular torsion, even with an apparently normal CDS, the surgical exploration is recommended.

Acute Disease↗

PubMed1987

Laparoscopic salpingectomy for tubal pregnancy.

This study presents 100 consecutive cases of total salpingectomy by laparoscopy for the treatment of ampullar ectopic pregnancy. A three-puncture technique was used, and the salpingectomy was done by thermocoagulation and transection of the isthmus, mesosalpinx, and tubo-ovarian ligament. Tubal extraction was accomplished by one of the suprapubic punctures with the use of a polyp forceps. No complications have been encountered during the operation. However, because of severe pelvic adhesions or a voluminous hematocele, laparotomy was used in two cases (2%). The only postoperative complication was a deep vein thrombosis in one of the patients. A second-look operation was performed in 36 cases, and good healing with no adhesion formation at or near the site of salpingectomy was found. This technique therefore appears to be simple, fast, and almost complication-free.

Electrocoagulation↗

PubMed1996

Painless scrotal masses in the pediatric population: prevalence and age distribution of different pathological conditions--A 10 year retrospective multicenter study.

PURPOSE: In the pediatric population a broad spectrum of intrascrotal pathology ranging from congenital to neoplastic lesions present as a painless scrotal mass. The aim of our 10-year retrospective study was to review 71 pediatric cases of a painless scrotal mass to determine the overall and age specific prevalence of diseases manifesting as such masses. MATERIALS AND METHODS: From 1980-1991, 71 patients 1 day to 16 years old with a painless scrotal mass underwent evaluation using 7.5 or 10 MHz. ultrasound probes with transverse and longitudinal sections. RESULTS: The painless scrotal mass was testicular in 61 cases (86%, 28 neoplasms, 27 congenital malformations, and 6 posttraumatic/inflammatory lesions) and extratesticular in 10 (14%, 5 neoplasms, 2 hematoceles, 2 pachyvaginitis and 1 sebaceous cyst). Patient age distribution showed 2 peaks at 0 to 1-year and 13 to 14-year intervals. More than a third of the painless scrotal masses (24 cases) were found during the first year of life, predominantly congenital anomalies (in utero torsion) and neoplasia. A total of 45 patients (63%) underwent surgery (orchiectomy in 39 and conservative treatment in 6) and a pathognomonic echo pattern allowed nonsurgical treatment in 26 (37%). CONCLUSIONS: Testicular ultrasound proved to be highly reliable in differentiating intratesticular from extratesticular lesions but it demonstrated poor specificity because of extensive overlap between benign and malignant pathologies. Therefore, testicular ultrasound changed the management of a few select cases of a painless scrotal mass (epididymal cysts/spermatoceles and in utero torsion).

Adolescent↗

PubMed1988

Etiology of acute scrotum in 100 boys with regard to age distribution.

A review of 100 boys less than 15 years old who were hospitalized for an acute scrotum revealed that the most common causes of the disorder were testicular torsion, including torsion of the spermatic cord (42 per cent) and torsion of the appendages (32 per cent). The remaining 26 per cent of the cases were owing to idiopathic scrotal edema (8 per cent), epididymitis and orchitis (6 per cent each), and incarcerated hernia and acute hematocele (3 per cent each). The age distribution of these children was biphasic, with the highest frequency in newborns (with exclusively extravaginal torsion) and in boys 13 years old, whereas in boys with appendiceal torsion the single peak frequency was at age 10 years. While idiopathic scrotal edema occurred in children less than 7 years old and orchitis in patients more than 12 years old, epididymitis was observed in young boys and those of pubertal age.

Acute Disease↗

PubMed2003

[Blunt testicular injury - conservative or surgical treatment?].

INTRODUCTION: Testicular trauma can be classified into blunt or penetrating injury. While every case of penetrating trauma is subjected to surgical treatment, the decision between surgery and conservative treatment must be made for each case of blunt injury. Inspection, palpation and duplex sonography may be helpful in finding the correct decision. Herein we present a case report and review of the current literature. CASE REPORT: A 14-year-old boy was admitted to an urological department after blunt scrotal trauma. Ultrasound examination revealed a peritesticular hematoma. After 9 days of conservative treatment, surgical exploration and orchidectomy for rupture of the tunica albuginea was performed. CONCLUSIONS: The following recommendations can be made for treatment of blunt testicular injury: if rupture of the testis is detected sonographically, immediate surgical exploration is indicated. Every change in testicular structure must be considered a possible sign of testicular rupture. Sonographically detected hematoceles without visible signs of rupture are not given clear recommendations in the literature. However, early surgical intervention (within 72 hours) seems to increase the likelihood of preserving the testis. In every case of unclear clinical or sonographic findings, surgical exploration of the scrotum should be done. If offers a safe and quick diaganosis with a very low complication rate.

Adolescent↗

PubMed1996

Cystic transformation of the rete testis.

In a review of the testicular and epididymal specimens obtained from autopsies (1,798 men) or surgery (518 men), cystic transformation of the rete testis (CTRT) was found in 20 autopsies and 18 surgical specimens. When both testes were studied (autopsies), the lesion was bilateral. Ultrasonography revealed a widened mediastinum testis showing small hypoechoic areas. Arteriography showed thin or irregularly outlined testicular arteries, and the epididymal artery was lacking or appeared stenosed. Simple CTRT (without epithelial alteration) was found in both testes of 17 autopsied patients (all were elderly men) and in eight surgically removed testes from patients with sarcoma, tuberculous orchidoepididymitis, or hematocele. The most frequent epididymal lesion was bilateral efferent duct atrophy. In three patients, the rete testis presented nodular proliferation of calcifying connective tissue. CTRT with columnar transformation of the rete testis epithelium was observed in both testes from three patients with alcoholic cirrhosis, and in 10 surgically removed testes from patients with testicular tumor, cryptorchidism, or nonspecific orchitis. In cirrhotic patients, the efferent ducts appeared atrophied. In patients with testicular tumors, the efferent ducts were infiltrated by carcinoma in situ cells (CISs) and often contained granular material, cell debris, or hyaline globules. In both kinds of CTRT (without or with epithelial metaplasia), the most frequent seminiferous tubule lesions were tubular ectasia, hypospermatogenesis, tubular sclerosis, spermatogonium arrest, and sloughing of immature germ cells (spermatids and spermatocytes). The mechanism leading to CTRT might be mechanic (compression of the epididymis by an epididymal tumor or a spermatic cord tumor, or the result of a long-standing epididymitis or traumatic hemocele); ischemic (autopsied elderly men); hormonal (cirrhotic patients); malformative (cryptorchidism); or unknown (the remaining cases).

Adolescent↗

PubMed1989

Testicular ischemia and infarction following herniorrhaphy or varicocelectomy: evaluation by radionuclide imaging.

The postoperative use of testicular imaging to evaluate the preservation of testicular circulation has been reported after orchiopexy, excision of a hematocele, and repair of a traumatized tunica albuginea. The authors discuss the previously unreported use of testicular imaging in patients who have undergone recent herniorrhaphy or varicocelectomy. The scan of a patient with intact testicular perfusion following herniorrhaphy is compared to the scans of two patients with absence of perfusion of a testicle five to seven days following respective herniorrhaphy and varicocelectomy surgeries.

Adult↗

PubMed1976

Unusual masses in the spermatic cord: report of six cases and review of the literature.

Differential diagnosis of spermatic cord swellings includes direct inguinal hernia, hydrocele, spermatocele, hematocele, lipoma, tuberculosis, and filariasis. This communication focuses attention on other unusual swellings of the spermatic cord. Three cases of sarcoma, two cases of foreign body in the spermatic cord, and one case of vasitis are presented. Although unusual, these conditions should be considered in the differential diagnosis of spermatic cord swellings.

Adolescent↗

PubMed1994

Diffuse echoes within a simple hydrocele: an imaging caveat.

Low-level swirling echoes were noted in scrotal fluid that ultimately proved to be a hydrocele. This sonographic appearance is similar to a hematocele or pyocele and potentially can cause confusion. We evaluated 14 patients with hydroceles and found these swirling echoes in nine. In each of these patients, the echoes were readily apparent with increased gain and were distinguished from artifact by their motion. We analyzed the fluid from one hydrocele and found high protein levels. We propose that protein aggregates account for these echoes. This appearance should not be confused with that resulting from a traumatic or infectious cause.

Adult↗

PubMed2000

[Locoregional anesthesia in inguinal hernia surgery].

BACKGROUND: It is a current opinion that local anesthesia (LA) is the primary choice in surgical treatment of the inguinal region, particularly herniorrhaphy. The LA technique personally used for herniorrhaphy is described: it consists of iliohypogastric, ilioinguinal and genito-femoral nerve blocks, and incision line anesthetic infiltration. METHODS: From January 1998 to April 1999, 95 patients underwent inguinal herniorrhaphy employing LA: 77 (81%) in elective surgery, 18 (19%) in emergency; 2 cases with bilateral hernia (97 total LA procedures). RESULTS: Partial success was obtained in only 8 cases (8.4%), which required an association with a hypnotic drug ("blended anesthesia": propofol or midazolam): there were no cases of conversion to general anesthesia. Specific complications of local anesthetic drugs infiltration developed in 8 cases on 97 LA procedures (8.2%), but none required reoperation: 6 inguinal hematomas, 1 female external genitalia hematoma, 1 hematocele. CONCLUSIONS: In conclusion, it is stressed that LA is the technique of choice in herniorrhaphy and surgery of other inguinal pathologies, associating high success rates, rare complications and rapid dismissal: this allows for easy management of the patients and a very important reduction of sanitary costs. The association of LA-hypnotic drugs (blended anesthesia) represents another important resource, since it avoids general anesthesia in many cases and allows a rapid psychophysical recovery.

Adult↗

PubMed1992

[Sclerosing therapy of testicular hydrocele with tetracycline].

Twenty-six patients, aged 38 to 78 years, with testicular hydrocele were treated by aspiration, punction and tetracycline instillation. The cure rate was 79%. Inflammation of the scrotum was observed in all of the cases. Due to recurrence two patients underwent surgery, which revealed a hematocele.

Adult↗

PubMed2005

[Endoscopic decompression of optic canal].

OBJECTIVE: To evaluate the effectiveness of endoscope in the treatment of optic nerve injury. METHODS: Thirteen patients with fracture at the inner and lower walls of optical canal underwent endoscopic decompression. The posterior 1/3 of the middle concha, the posterior ethmoid sinus and sphenoid sinus were opened, chips of bone and old hematocele were scavenged, and the optic ring of the optic canal was polished; however, the sheath of the optic nerve remained intact. In 2 cases with the dura broken at the cranial part of optic nerve, the broken site was covered with mucosa of middle concha, and the sphenoid sinus and the middle nasal meatus were covered with oil ribbon gauze. Three days after the operation, the ribbon gauze was pulled put, however, if cerebro-spinal fluid leakage was suspected, the ribbon gauze was pulled out 7-10 days after. After the operation the visual acuity improvement reaching one grade or more and improvement of visual field were defined as effective. RESULTS: Five of the 6 patients without light perception before the operation showed improvement in visual acuity. The other 7 patients with residual visual acuity all recovered to different extents. CONCLUSION: A mini-invasive surgery, decompression of optic canal with endoscope is effective in decompressing optic nerve, decreasing the injury of optic nerve, and the patients recover quickly after operation.

Adolescent↗

PubMed1998

Spermatic cord hematoma in a collegiate football player: a case report.

OBJECTIVE: In order to expand the athletic trainer's awareness of acute scrotal injuries, the objective is to present a case of a collegiate football player sustaining a spermatic cord hematoma injury. BACKGROUND: Hematomas tend to resolve with conservative management. However, untreated testicular injuries may have serious ramifications, including ischemic atrophy, necrosis, and secondary infection. Exploratory surgery remains the standard for any acute scrotal lesion that cannot be diagnosed by physical examination or by diagnostic testing. Surgical exploration, however, is unnecessary in cases of scrotal hematoma. DIFFERENTIAL DIAGNOSIS: Epididymitis, incarcerated inguinal hemia, testicular torsion, testicular hematocele, and scrotal trauma with hematoma formation. TREATMENT: Conservative management including bedrest, ice, slight elevation of the lower extremities, and nonsteroidal anti-inflammatory drugs. UNIQUENESS: Noncontact scrotal injuries resulting in moderate swelling, pain, and disability are rare in athletes. This case study presents an athlete who suffered a moderate adductor strain 1 month before the formation of a spermatic cord hematoma. Comparison of the two episodes may be found in the subjective history. The question arises as to whether or not the hematoma formation was a possible complication of the initial adductor muscle injury. CONCLUSIONS: Although scrotal injuries are not life threatening, untreated testicular injures can have immediate and severe consequences. It is essential that athletes with acute scrotal injuries accompanied by swelling and tenderness be evaluated by a physician with training in clinical urology.

Journal Article↗