Isolated inguinal endometriosis. Case report with ultrasonographic preoperative diagnosis

Inguinal endometriosis is rare and accounts for 0.3-0.6% of patients affected by endometriosis. A correct preoperative diagnosis is rare. Diagnosis is frequently made by histologic examination. A 36-year-old nulliparous woman presented with a painful mass in her right groin of 2 years duration. The pain fluctuated according to the menstrual period. Physical examination revealed an elastic hard mobile mass measuring 2 x 2 cm in the right inguinal region. Ultrasound examination confirmed a hypoechoic tumor in the right inguinal region with poorly defined boundaries and perilesional and intralesional vascular flow suspect for endometriosis. Wide excision of the lump with a part of the round ligament was carried out. Histology showed endometrial glands and stroma within the fibrous tissue. The patient had an uneventful recovery and was discharged the next day. After surgery, the pain disappeared completely. No signs of recurrence occurred at approximately 16 months after the surgery. Although rare, extrapelvic endometriosis should be considered in the differential diagnosis in women of reproductive age presenting with an inguinal mass, especially if the groin mass is associated in size and tenderness with menstrual variability. US appearance is very useful in diagnosis so ultrasonography can be considered the examination of choice.     

Prenatal indicators of congenital cytomegalovirus infection

OBJECTIVE: To assess the validity of a diagnostic protocol designed to predict the outcome of newborns of mothers suspected to have primary cytomegalovirus (CMV) infection during the first 4 months of pregnancy. STUDY DESIGN: Anti-CMV immunoglobulin (Ig) M detection by enzyme immunoassay and immunoblot together with the determination of anti-CMV IgG avidity allowed us to classify 456 women as (1) uninfected, (2) undergoing either a primary or a recurrent infection, or (3) having an undefined serologic condition. Prenatal diagnosis was carried out at 21 to 23 weeks' gestation for women. The presence of the virus in the amniotic fluid was determined by culture, polymerase chain reaction, and quantitative polymerase chain reaction. Macroscopic and histologic examinations were undertaken on tissue from aborted fetuses, whereas for newborns culture was performed on urine sampled during the first week of life. RESULTS: Congenital infections were found exclusively among women undergoing a primary infection. The quantitative determination of CMV DNA in the amniotic fluid of at least 10(3) genome equivalents gave a 100% certainty of detecting an infected fetus. Higher viral loads were associated with fetuses or newborns with symptoms. CONCLUSIONS: IgM tests and the IgG avidity determination can identify all women at risk of transmitting CMV. Furthermore, a high CMV DNA load in amniotic fluid could be an indicator of symptomatic congenital infection at a relatively early stage of pregnancy.     

Continuing Medical Education Program in Echocardiography

Article Title: Long‐Term Outcome in Asymptomatic Patients with Severe Aortic Regurgitation, Normal Left Ventricular Ejection Fraction, and Severe Left Ventricular Dilatation
(Echocardiography 2010;27:914)