RESUMO
Using ultrasound findings and clinical characteristics, we constructed and validated a new nomogram for distinguishing epididymal tuberculosis from nontuberculous epididymitis, both of which share similar symptoms. We retrospectively examined data of patients with epididymal tuberculosis and nontuberculous epididymitis hospitalized between January 1, 2013, and March 31, 2023. Eligible patients were randomly assigned to derivation and validation cohorts (ratio, 7:3). We drew a nomogram to construct a diagnostic model through multivariate logistic regression and visualize the model. We used concordance index, calibration plots, and decision curve analysis to assess the discrimination, calibration, and clinical usefulness of the nomogram, respectively. In this study, 136 participants had epididymal tuberculosis and 79 had nontuberculous epididymitis. Five variables-C-reactive protein level, elevated scrotal skin temperature, nodular lesion, chronic infection, and scrotal skin ulceration-were significant and used to construct the nomogram. Concordance indices of the derivation and validation cohorts were 0.95 and 0.96, respectively (95% confidence intervals, 0.91-0.98 and 0.92-1.00, respectively). Decision curve analysis of this nomogram revealed that it helped differentiate epididymal tuberculosis from nontuberculous epididymitis. This nomogram may help clinicians distinguish between epididymal tuberculosis and nontuberculous epididymitis, thereby increasing diagnosis accuracy.
Assuntos
Epididimo , Epididimite , Nomogramas , Ultrassonografia , Humanos , Masculino , Epididimite/diagnóstico por imagem , Epididimite/microbiologia , Epididimite/diagnóstico , Ultrassonografia/métodos , Pessoa de Meia-Idade , Adulto , Diagnóstico Diferencial , Estudos Retrospectivos , Epididimo/diagnóstico por imagem , Epididimo/patologia , Tuberculose dos Genitais Masculinos/diagnóstico por imagem , Tuberculose dos Genitais Masculinos/diagnóstico , Tuberculose/diagnóstico por imagem , Tuberculose/diagnóstico , IdosoRESUMO
OBJECTIVE: To discuss the clinical application value of contrast-enhanced ultrasound (CEUS) in testicular occupied lesions. METHODS: Nine conventional-ultrasound-found testicular occupied lesions which underwent CEUS meantime were analyzed retrospectively. The CEUS perfusion pattern was compared with the surgical pathological result or follow-up findings. RESULTS: Among all the 9 testicular occupied lesions, there were 5 testicular malignant tumors, 1 testicular benign tumor, 1 testicular tuberculosis, and 2 testicular hematomas. CEUS diagnosed 6 testicular malignant tumors, 1 testicular benign tumor, and 2 testicular hematomas, and its diagnostic accuracy was about 88.9%. CONCLUSION: CEUS has high clinical application value in the differential diagnoses of benign and malignant testicular occupied lesions.
Assuntos
Doenças Testiculares/diagnóstico por imagem , Neoplasias Testiculares/diagnóstico por imagem , Adulto , Biologia Computacional , Meios de Contraste , Diagnóstico Diferencial , Erros de Diagnóstico , Hematoma/diagnóstico por imagem , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Neoplasias Embrionárias de Células Germinativas/irrigação sanguínea , Neoplasias Embrionárias de Células Germinativas/diagnóstico por imagem , Fosfolipídeos , Estudos Retrospectivos , Hexafluoreto de Enxofre , Neoplasias Testiculares/irrigação sanguínea , Tuberculose dos Genitais Masculinos/diagnóstico por imagem , Ultrassonografia/métodos , Ultrassonografia/estatística & dados numéricosRESUMO
Urogenital tuberculosis is the most common form of extrapulmonary tuberculosis. Genital organ involvement occurs as a continuum of urinary tract tuberculosis and often presents a diagnostic challenge due to the non-specific nature of the symptoms. Delay in diagnosis may lead to complications such as infertility and perineoscrotal sinuses. Imaging plays an important role in raising timely suspicion of tuberculosis. In this article, we describe the imaging findings of male genital tuberculosis and the differential diagnosis. High-resolution ultrasonography (HRUS) is the best modality for assessing the epididymis, testis, scrotum and vas deferens, whereas MRI is optimal for evaluating the prostate, seminal vesicles and ejaculatory ducts. Epididymis is the most common site of genital tuberculosis, and presents as a nodular lesion limited to the tail or as diffuse enlargement. The proximal vas deferens is also frequently involved due to anatomical contiguity and shows diffuse or nodular thickening. Advanced cases may show pyocele formation and scrotal wall sinuses. Testicular involvement is almost always secondary to epididymal tuberculosis and presents as single or multiple nodules, diffuse enlargement, or the 'miliary' pattern. Isolated testicular involvement should raise suspicion of malignancy. Tuberculosis of the prostate is often asymptomatic. The most common imaging manifestations are nodules and the diffuse forms, which may later evolve into abscesses. Fibrosis and calcification occur with healing. Seminal vesicle and ejaculatory duct involvement with fibrosis may cause infertility. Awareness of the imaging findings would enable the radiologist to raise timely suspicion, so that prompt treatment is initiated and complications are prevented.
Assuntos
Doenças dos Genitais Masculinos , Tuberculose dos Genitais Masculinos , Tuberculose , Diagnóstico Diferencial , Epididimo , Doenças dos Genitais Masculinos/diagnóstico por imagem , Genitália Masculina , Humanos , Masculino , Tuberculose dos Genitais Masculinos/diagnóstico por imagemAssuntos
Epididimite/diagnóstico por imagem , Orquite/diagnóstico por imagem , Tuberculose dos Genitais Masculinos/diagnóstico por imagem , Tuberculose dos Genitais Masculinos/microbiologia , Ultrassonografia/métodos , Adulto , Antituberculosos/uso terapêutico , Biópsia por Agulha Fina/métodos , Diagnóstico Diferencial , Epididimite/microbiologia , Epididimite/patologia , Humanos , Masculino , Orquite/microbiologia , Orquite/patologia , Tuberculose dos Genitais Masculinos/tratamento farmacológico , Tuberculose dos Genitais Masculinos/patologiaRESUMO
OBJECTIVES: To evaluate the role of scrotal ultrasound in the follow-up after epididymitis for underlying serious testicular pathologies, which could be overseen in the acute phase. METHODS: Retrospective chart reviews were performed for patients diagnosed with acute epididymitis at Herlev-Gentofte Hospital between 2006 and 2013. Patients were included if they had received the diagnosis after a clinical evaluation in the emergency department and had subsequently undergone antibiotic treatment and a follow-up scrotal ultrasound at a later date. RESULTS: Overall, 118 patients fulfilled the inclusion criteria. The median age was 45 years (range = 18-80). The follow-up ultrasound scans showed no signs of significant pathology in 92/118. Incidental findings of hydroceles, spermatoceles, and varicoceles were made in eight, five and five of the 118, respectively. One patient had testicular tuberculosis and one had neglected testicular torsion. Six patients were diagnosed with suspicious testicular lesions and underwent surgery. Cancer was confirmed in four men (27, 32, 40, and 45 years old). CONCLUSIONS: Epididymitis can be diagnosed and treated correctly without scrotal ultrasound in the majority of cases. However, the risk of underlying testicular cancer should be kept in mind. Patients below 50 years of age without bacteriuria and patients with persistent symptoms after antibiotic treatment should be referred to an urologist for a re-evaluation or for a follow-up ultrasound.
Assuntos
Assistência ao Convalescente/métodos , Epididimite/diagnóstico por imagem , Neoplasias Testiculares/diagnóstico por imagem , Testículo/diagnóstico por imagem , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Ciprofloxacina/uso terapêutico , Epididimite/tratamento farmacológico , Genitália Masculina/diagnóstico por imagem , Hospitais Universitários , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Torção do Cordão Espermático/diagnóstico por imagem , Espermatocele/diagnóstico por imagem , Hidrocele Testicular/diagnóstico por imagem , Tuberculose dos Genitais Masculinos/diagnóstico por imagem , Ultrassonografia , Varicocele/diagnóstico por imagem , Adulto JovemRESUMO
The prevalence of tuberculosis in Denmark is low compared to many developing countries. It is most commonly found in socially marginalized communities. We present an unusual case of a man, who was referred to urological treatment as a computed tomography had showed a tumour with a suspicious process in the left scrotum and in relation to the left seminal vesicle. Histopathology of the testis showed granuloma formation. A Ziehl-Neelsen staining showed no acid-fast bacilli, but polymerase chain reaction revealed Mycobacterium tuberculosis. Antituberculous treatment was commenced.
Assuntos
Achados Incidentais , Doenças Testiculares/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Tuberculose dos Genitais Masculinos/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Although tuberculosis (TB) is a curable disease, it continues to be one of the leading infections associated with death in the world. Extra-pulmonary TB (EPTB) occurs in approximately 10% of the total cases, presenting with lymph nodes, pleura, bone and genitourinary tract as the most common locations. Genitourinary tuberculosis, the second most common EPTB, is very difficult to diagnose unless there is a high index of suspicion. Isolated TB orchitis or prostatitis without clinical evidence of renal involvement is a rare entity among genitourinary tuberculosis. We presented the first reported case of TB prostatitis and orchitis associated with pulmonary TB and the presence of an acute massive caseous pneumonia in an immunocompetent man. Despite the anti-TB therapy, the patient presented a rapid progression of disease and deterioration of general conditions taking to death, which occurred four days after TB treatment had started. Disseminated TB is a relatively uncommon cause of acute massive caseous pneumonia; however, there should always be suspicion of the disease, since it is a potentially treatable cause. This rare case supports the assertion that TB should be considered as an important differential diagnosis of genitourinary tumors irrespective of evidence of active TB elsewhere in the body.
Assuntos
Progressão da Doença , Tuberculose dos Genitais Masculinos/diagnóstico por imagem , Tuberculose Pulmonar/diagnóstico por imagem , Evolução Fatal , Humanos , Hospedeiro Imunocomprometido , Masculino , Pessoa de Meia-Idade , Tuberculose dos Genitais Masculinos/patologia , Tuberculose Pulmonar/patologiaRESUMO
ABSTRACT Although tuberculosis (TB) is a curable disease, it continues to be one of the leading infections associated with death in the world. Extra-pulmonary TB (EPTB) occurs in approximately 10% of the total cases, presenting with lymph nodes, pleura, bone and genitourinary tract as the most common locations. Genitourinary tuberculosis, the second most common EPTB, is very difficult to diagnose unless there is a high index of suspicion. Isolated TB orchitis or prostatitis without clinical evidence of renal involvement is a rare entity among genitourinary tuberculosis. We presented the first reported case of TB prostatitis and orchitis associated with pulmonary TB and the presence of an acute massive caseous pneumonia in an immunocompetent man. Despite the anti-TB therapy, the patient presented a rapid progression of disease and deterioration of general conditions taking to death, which occurred four days after TB treatment had started. Disseminated TB is a relatively uncommon cause of acute massive caseous pneumonia; however, there should always be suspicion of the disease, since it is a potentially treatable cause. This rare case supports the assertion that TB should be considered as an important differential diagnosis of genitourinary tumors irrespective of evidence of active TB elsewhere in the body.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Progressão da Doença , Tuberculose dos Genitais Masculinos/diagnóstico por imagem , Tuberculose Pulmonar/diagnóstico por imagem , Evolução Fatal , Hospedeiro Imunocomprometido , Tuberculose dos Genitais Masculinos/patologia , Tuberculose Pulmonar/patologiaRESUMO
An 18-year-old boy, a refugee from Afghanistan, with no significant medical history, presented after 1â day of severe left testicular pain. History, clinical examination and scrotal ultrasound suggested the diagnosis of epididymo-orchitis. He was discharged on a 2-week course of amoxicillin/clavulanic acid. Six weeks later, he re-presented with a testicular abscess, continuous with the epididymal head. Incision and drainage led to laboratory confirmation of tuberculous infection. He was treated with isoniazid, rifampicin, ethambutol, pyrazinamide and vitamin B6 for 9â months, with good response. Despite meeting high-risk criteria for tuberculosis, our patient had a delayed diagnosis. We present the case and discuss the lessons learned.
Assuntos
Epididimo , Orquite/etiologia , Escroto , Tuberculose dos Genitais Masculinos/diagnóstico , Adolescente , Antituberculosos/uso terapêutico , Diagnóstico Diferencial , Epididimo/diagnóstico por imagem , Epididimo/patologia , Humanos , Masculino , Orquite/diagnóstico , Orquite/diagnóstico por imagem , Escroto/diagnóstico por imagem , Escroto/patologia , Tuberculose dos Genitais Masculinos/complicações , Tuberculose dos Genitais Masculinos/diagnóstico por imagem , Tuberculose dos Genitais Masculinos/tratamento farmacológico , UltrassonografiaRESUMO
Genitourinary tract is the second most common site where extrapulmonary tuberculosis (TB) occurs. Genitourinary TB is notable for a latent clinical course and difficult diagnosis. The paper presents clinical observations of two patients treated in a urology department of a general public hospital. One of them was diagnosed with tuberculosis of the prostate, MTB+. In the other, TB of the prostate was suspected based on pathologic assessment of the surgical specimen after surgery for prostate cancer.
Assuntos
Doenças Prostáticas/diagnóstico , Tuberculose dos Genitais Masculinos/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS , Adulto , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doenças Prostáticas/diagnóstico por imagem , Doenças Prostáticas/patologia , Doenças Prostáticas/cirurgia , Tuberculose dos Genitais Masculinos/diagnóstico por imagem , Tuberculose dos Genitais Masculinos/patologia , Tuberculose dos Genitais Masculinos/cirurgia , UltrassonografiaAssuntos
Epididimite/diagnóstico por imagem , Tuberculose dos Genitais Masculinos/diagnóstico por imagem , Idoso , Diagnóstico Diferencial , Epididimite/cirurgia , Humanos , Masculino , Orquiectomia , Recidiva , Escroto/diagnóstico por imagem , Escroto/cirurgia , Tuberculose dos Genitais Masculinos/cirurgia , UltrassonografiaRESUMO
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.
Assuntos
Epididimite/diagnóstico por imagem , Escroto/diagnóstico por imagem , Tuberculose dos Genitais Masculinos/diagnóstico por imagem , Ultrassonografia/métodos , Ducto Deferente/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Humanos , MasculinoRESUMO
The purpose of this report is to describe findings of clinical examination and imaging in a 27-year-old man admitted for nonpainful left testicular enlargement. Initial diagnosis was testicular cancer based on ultrasonography and association with pulmonary metastasis. This diagnosis was revised after histological study demonstrated testicular tuberculosis.
Assuntos
Erros de Diagnóstico , Neoplasias Testiculares/diagnóstico por imagem , Testículo/diagnóstico por imagem , Tuberculose dos Genitais Masculinos/diagnóstico por imagem , Adulto , Doenças Endêmicas , Humanos , Masculino , UltrassonografiaRESUMO
A 65-year-old man who had multiple lymph nodes swelling was pathologically diagnosed with diffuse large B cell lymphoma. After initiation of induction chemotherapy, F-18 FDG PET/CT showed a significantly decreased extent of previous lymphomatous lesions except for 2 newly developed focal hypermetabolic lesions in the prostate and left epididymis. The specimens from the prostate and orchiectomy revealed tuberculosis lesions. After a 3-month antituberculosis regimen, there was definitively decreased glucose uptake in the prostate on F-18 FDG PET. F-18 FDG PET may be helpful for characterizing genitourinary tuberculosis and monitoring antituberculosis treatment.
Assuntos
Fluordesoxiglucose F18 , Linfoma/diagnóstico , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X , Tuberculose dos Genitais Masculinos/diagnóstico , Idoso , Diagnóstico Diferencial , Humanos , Linfoma/diagnóstico por imagem , Masculino , Recidiva , Tuberculose dos Genitais Masculinos/diagnóstico por imagemRESUMO
Diagnosis of extrapulmonary tuberculosis (TB) is often missed or delayed because of nonspecific clinical and laboratory findings. Novel detection methods, such as polymerase chain reaction and QuantiFERON-TB Gold In Tube, can aid in the diagnosis of active extrapulmonary TB. Here, we demonstrate a case of epididymo-orchitis as the sole presentation of TB in a 32-year-old man.
Assuntos
Ensaio de Imunoadsorção Enzimática/métodos , Epididimite/microbiologia , Orquite/microbiologia , Reação em Cadeia da Polimerase/métodos , Tuberculose dos Genitais Masculinos/diagnóstico , Adulto , Antibióticos Antituberculose/uso terapêutico , Epididimite/diagnóstico por imagem , Epididimite/tratamento farmacológico , Humanos , Masculino , Orquite/diagnóstico por imagem , Orquite/tratamento farmacológico , Rifampina/uso terapêutico , Testículo/diagnóstico por imagem , Tuberculose dos Genitais Masculinos/diagnóstico por imagem , Tuberculose dos Genitais Masculinos/tratamento farmacológico , UltrassonografiaRESUMO
Genitourinary tuberculosis is the common manifestation of extra-pulmonary tuberculosis. In the male genital tract, the epididymis followed by seminal vesicle, prostate, vas deferens and testis are commonly affected sites. Ultrasonography (USG) is the best imaging modality for the diagnosis of the diseases of male genital tract. We are presenting USG findings in two cases of male genital tuberculosis with involvement of the prostate, seminal vesicle, epididymis and vas deferens.
Assuntos
Epididimo/diagnóstico por imagem , Próstata/diagnóstico por imagem , Glândulas Seminais/diagnóstico por imagem , Testículo/diagnóstico por imagem , Tuberculose dos Genitais Masculinos/diagnóstico por imagem , Ducto Deferente/diagnóstico por imagem , Adulto , Diagnóstico Diferencial , Humanos , Masculino , UltrassonografiaRESUMO
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.