Scrotal enlargement following inguinal herniorrhaphy: Ultrasound evaluation

Although sonography has become an established modality in the evaluation of acute and chronic scrotal abnormalities, its role in the post-herniorrhaphy patient with scrotal swelling has not yet been defined. We present 5 patients with immediate and delayed complications of herniorrhaphy in which sonography provided useful clinical information. Immediate complications included scrotal hematomas, scrotal wall and septal thickening, epididymitis, and testicular displacement. Delayed complications included an infected hydrocele demonstrating a fluid-debris level. The etiology of scrotal swelling in postherniorrhaphy patients can be determined with sonography.     

Scrotal ultrasound

Ultrasound has been shown to be a reliable and valuable tool in the diagnosis of scrotal abnormalities. In this article, a comprehensive discussion of scrotal abnormalities and their ultrasonographic appearance is presented, oriented toward common clinical presentations, and the present uses and indications of scrotal ultrasound are enumerated.     

Scrotal ultrasound

Since its development in the late 1970s, scrotal ultrasound has been used successfully to diagnose and evaluate many pathologic processes. At present, except for evaluation of a few entities, it is the diagnostic imaging modality of choice. Differentiation of normal from abnormal scrotal contents is possible with great accuracy. The technique is capable of differentiating cystic from solid lesions and testicular from extratesticular disease with an accuracy approaching 100%. It has also been used successfully for evaluation of some causes of male infertility and various congenital abnormalities. Evaluation of spermatic cord torsion and undescended testes is generally better done with other techniques. Scrotal ultrasound, however, is still used as a complementary, but not the primary, study for these diagnoses.     

高频超声诊断新生儿卵巢增大、并腹股沟疝的临床意义

新生儿期卵巢增大,可形成卵巢囊肿、影响卵巢进入正常位置而形成腹股沟疝,导致小儿性早熟,影响小儿身高及心理发育等。自2006年1月-6月我们连续发现5例新生儿卵巢增大,予以报道。1材料与方法临床资料见表1,应用彩色多普勒超声诊断仪:Philps HD、HDI 5000,高频探头7-10mmHz。行常规下腹部及腹股沟、会阴区扫查。2结果超声检查所见及诊断结果见表1。表1 5例临床资料与超声检查结果比较异及丘脑-垂体-卵巢器质性病变产生过多激素,刺激胎儿卵巢内卵泡增生过大、内液潴溜,是导致卵巢增大的原因[3]。5例新生儿8枚卵巢增大的原因分析,说明胎儿期…     

Scrotal ultrasonography: a clinical evaluation

Two hundred and thirty patients had scrotal ultrasonography over an 18-month period. We report the ultrasound findings, correlation with the clinical diagnosis and, where possible, with the pathological diagnosis. The results show the value of scrotal ultrasonography in clinical practice. Of particular interest is the ultrasonic examination of the clinically normal or impalpable testis and the correct ultrasound diagnosis of testicular tumour in five cases (2% of all cases, 28% of tumours detected) thought clinically to be benign. A brief review of abnormal appearances is included.     

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.     

Scrotal calcification: ultrasound appearances, distribution and aetiology

This pictorial review illustrates the ultrasound appearances of scrotal calcification, distinguishing between intratesticular and extratesticular calcification. Intratesticular calcification may be due to phleboliths, spermatic granulomas or vascular calcification, or it may occur in association with tumours. Extratesticular calcification is more frequently encountered and is usually related to previous inflammatory disease of the epididymis. Testicular microlithiasis, a rare condition characterized by multiple scattered echogenic foci within the testis, is produced by the formation of microliths from degenerating cells in the seminiferous tubules. Testicular microlithiasis has been demonstrated as an incidental finding as well as in association with both benign and malignant tumours of the testis.     

Scrotal changes in the 3.5 MHz ultrasound image

Sonography enables sensitive detection of pathological changes in the scrotum, since the planes of intersection can be selected as may be required, and since local resolution is excellent. However, sonographic criteria alone do not permit differential diagnosis of malignomas against benign changes. Anamnesis and clinical examination are of equal importance as sonography. Diagnostic conclusions are possible only if all the findings based on all the diagnostic approaches are combined in synopsis. Although reports published in recent years postulated transducer either of a frequency higher than 3.5 mHz (1, 5, 11, 12, 13, 14, 17, 20, 21, 24, 25, 27) or low-frequency transducers associated with immersion technique (7, 23), in our patients the use of a 3.5 mHz convex scanner with water forerun resulted always in confirming the diagnosis (in conjunction with anamnesis and clinical findings). In our experience a transducer of this frequency (3.5 mHz) with water forerun appears to be suitable for routine diagnosis of changes in the scrotum. This is an important aspect in general practice, where ultrasound equipment is often fitted with 3.5 mHz transducers.     

充填式无张力疝修补术在28例老年患者复发性腹股沟疝中的应用

1　临床资料1 1　一般资料　本组 2 8例 ,男 2 5例 ,女 3例。年龄为 60～80岁。既往在本院手术者 9例 ,外院手术者 19例。1 2　复发类型　单侧复发 2 6例 ,双侧复发 2例 ,其中直疝 6例 ,直疝斜疝同时存在 2例。在本院以前施行手术的 9例 ,均为第 1次复发。1 3　复发次数　第 1次复发 2 3例 ,第 2次复发 3例 ,第 3次复发 1例 ,第 4次复发 1例 ,双侧疝中 1例为第 1次复发 ,1例1侧为第 2次复发。1 4　复发时间　多次复发者指最后一次手术距复发时间。1个月内复发者有 4例 ,2～ 3个月者 7例 ,1ａ以上者 12例 ,5ａ以上者 4例 ,最长 1例为 12ａ后…     

Scrotal ultrasound. Part II: Cysts,tumors and rare non tumoral processes

Pathological processes of the scrotum are very numerous. They are composed by few common well known diseases and a large spectrum of rare lesions. The testis may be involved by some systemic diseases. Ultrasound is the main modality for scrotal imaging and complementary to clinical evaluation. When a tumoral process is suspected, surgery is required to confirm the diagnosis and provide histology. The role of MR remains under evaluation.     

Scrotal US for evaluation of infertile men with azoospermia

PURPOSE: To evaluate prospectively the accuracy of scrotal ultrasonography (US) in distinguishing obstructive azoospermia from nonobstructive azoospermia in infertile men by using histologic findings as the reference standard. MATERIALS AND METHODS: The institutional review board approved the study, and informed consent was obtained from each patient. Twenty infertile men (mean age, 34.7 years; 40 testes) with azoospermia were evaluated at scrotal US, with an emphasis on the course of the proximal genital duct: mediastinum testis, epididymal head, epididymal body, and epididymal tail. Testicular volumes were calculated by using the formula: length x height x width x 0.71. On the basis of histologic results, azoospermia was divided into two groups (obstructive vs nonobstructive) in all cases except one. Scrotal US findings between obstructive and nonobstructive azoospermia were compared. The Fisher exact and Wilcoxon signed rank sum tests were used to assess differences between both groups. RESULTS: Of 20 infertile men with azoospermia, 14 were proved to have obstructive azoospermia; the others had nonobstructive azoospermia. According to US findings, epididymal abnormalities in the head, body, and tail were significantly associated with obstructive azoospermia (17 [61%], 18 [64%], and 20 [71%] of 28 testes, respectively; P < .001 for all), while abnormalities of the mediastinum testis between both groups were not significant (P > .05). By taking epididymal abnormalities into account, sensitivity, specificity, and accuracy of scrotal US for differentiation of obstructive from nonobstructive azoospermia were 82.1% (23 of 28 scrota), 100% (12 of 12 scrota), and 87.5% (35 of 40 scrota), respectively. The median testicular volume in obstructive azoospermia was 11.6 mL (range, 7.7-25.8 mL) and that in nonobstructive azoospermia was 8.3 mL (range, 1.2-16.4 mL) (P < .05). CONCLUSION: Evaluation of the epididymis and measurement of testicular volume with scrotal US are important in distinguishing obstructive azoospermia from nonobstructive azoospermia in infertile men.     

Scrotal disorders: evaluation of testicular enhancement patterns at dynamic contrast-enhanced subtraction MR imaging

PURPOSE: To evaluate testicular enhancement patterns in various scrotal disorders at dynamic contrast medium-enhanced subtraction magnetic resonance (MR) imaging. MATERIALS AND METHODS: Forty-two patients with scrotal symptoms (22 testicular diseases, 20 extratesticular scrotal disorders) underwent three-dimensional (3D) fast field-echo or fast spin-echo dynamic subtraction MR imaging after injection of paramagnetic contrast medium. The relative percentages of peak height and mean slope of the testes on the affected side were compared with those on the unaffected side by using time-signal intensity curves. RESULTS: Extratesticular scrotal disorders (time-signal intensity curve mean peak height, 93.1%; mean slope, 89.8%) showed gradual and progressive increase in homogeneous testicular contrast enhancement in all normal testes. Relative percentages of peak height and mean slope of testicular torsion (mean peak height, 17.3%; mean slope, 10.6%), infarction (mean peak height, 30.4%; mean slope, 19.8%), traumatic hemorrhagic necrosis (mean peak height, -3.5%; mean slope, -12.0%), and epidermoid cyst (mean peak height, -6.6%; mean slope, -14.2%) were significantly lower than those of extratesticular scrotal disorders. Acute mumps orchitis (mean peak height, 135.1%; mean slope, 307.5%) and malignant testicular tumor (mean peak height, 178.7%; mean slope, 467.6%) showed higher relative percentages of peak height and mean slope. CONCLUSION: Dynamic contrast-enhanced subtraction MR imaging can provide information about testicular perfusion on the basis of contrast enhancement and can be used to differentiate testicular diseases from scrotal disorders.     

Role of ultrasound in diagnosis of neonatal breast enlargement: a newborn case report

Neonatal breast enlargement is a hormone-related condition, mostly asymptomatic\physiological, with a well-recognizable sonographic appearance but limited data in the literature. It can be uni-or bilateral. Typically described in the first week of life, the transient lesion disappears spontaneously within 6 months. The main differential diagnosis is neonatal mastitis, a breast tissue infection that requires a specific antibiotic therapy. Knowledge of clinical and imaging findings is crucial, and ultrasound represents a reliable tool which allows a quick identification and an excellent examination of neonatal breast abnormalities. We aim to highlight sonographic classic features of benign neonatal breast enlargement showing how ultrasound rules out real breast masses helping to differentiate between it and mastitis when clinical and laboratory data are inconclusive. We describe a 2-day-old male with bilateral breast swelling more pronounced on the right side.     

Musculoskeletal ultrasound: evaluation of the finger

OBJECTIVE: Ultrasound is well suited for evaluating the superficial structures of the finger. The purpose of this video article is to review basic anatomy, scanning techniques, and sonographic appearance of the tendons, pulleys, and ligaments of the finger. Examples of pathologic conditions that can affect these structures will be shown. Please note that the large size of this file may result in several minutes of download time. CONCLUSION: Ultrasound is an established safe, efficient, and cost-effective method to evaluate structures in the finger. Knowledge of anatomy and technique is essential for scanning the finger accurately and effectively. The dynamic capability of ultrasound is especially helpful in evaluating for tendon and pulley injury and pathology.     

Histopathological evaluation of five unusual gingival enlargement cases

Gingival fibromatosis represents the fibrous hyperplasia of the gingival tissue. Clinical examination reveals enlargement of buccal and palatal gingival tissue. Many forms of gingival fibromatosis are of unknown etiology and termed as idiopathic gingival fibromatosis. However, several authors use various terms such as gingivomatosis and elephantiasis to describe these lesions. Our aim in this case report is to present five patients (one female, four males) with unusual clinical forms of gingival hyperplasia and to discuss the histopathological and clinical features in comparison to similar enlargements. Clinical examinations did not reveal increased periodontal pocket depths, besides plaque and gingival index scores were found to be in normal range. All of the patients were systemically healthy and were not subject to medications, which could lead to gingival hyperplasia. Additionally, clinical appearance of the lesions did not show any signs of trauma. Excisional biopsies were performed in all cases. The pathological examinations of the specimens demonstrated fibroconnective tissue characteristics, which were in accordance with the clinical appearance of all patients. Lesions healed successfully without sequelae or infection, and no recurrence was observed after 1-year follow-up.