Hematocele y hemoperitoneo como manifestación inicial de carcinoma hepatocelular: caso clínico / Hematocele and hemoperitoneum as initial manifestation of hepatocellular carcinoma: report of one case

Hepatocellular carcinoma (HCC) rupture is a rare complication, with a higher prevalence in countries of Asia and Europe. Its clinical manifestations can be nonspecific, from abdominal pain and bloating to hemodynamic involvement. We report a 70-year-old male patient with a history of chronic liver disease, presenting with an enlargement and ecchymosis of the scrotum, associated with abdominal bloating. The initial abdominal ultrasound study showed increased liquid content in the scrotal sac and regional edema. A CT of the abdomen and pelvis showed a liver mass with characteristics of hepatocellular carcinoma, associated with extensive hemoperitoneum that drained into the scrotal sac. The patient was treated with embolization of the right hepatic artery and later with surgical resection of the tumor mass, with a good clinical evolution.

Seminal vesiculoscopy: Past, status quo, and prospects / 中华男科学杂志

Seminal vesiculoscopy is a new technology in uro-andrology developed in recent 10 years, which is a set of clinical operational techniques for observing the ejaculatory duct, seminal vesicle, ampullar region of the vas deferens and their surrounding structure, determining the cause, location and degree of the disease, and accomplishing such treatment procedures as irrigation, resection, incision, fulguration, hemostasis, expansion, drainage, and removal of hematocele, stones or obstruction in the distal seminal duct region. Therefore, it is not only an etiologically diagnostic technique, but also a minimally invasive surgical approach to the management of common diseases of the distal seminal duct region. Seminal vesiculoscopy has irreplaceable advantages of safety, effectiveness, minimal invasiveness, rapid recovery, and few complications.

Sonographic Features of Vasectomy-Related Changes and Abnormalities in the Scrotum

This article presents changes in the testis and epididymis after a vasectomy as well as illustrate the various vasectomy-related abnormalities on sonographic examination. In patients with scrotal pain after a recent vasectomy, the sonographic findings include enlargement of the epididymis with an ill-defined border and hematoma, or a hematocele surrounding the testis and epididymis. Vasectomy-related changes are likely attributable to post-vasectomy obstructive changes and increased intraluminal pressure in the efferent ducts, epididymides, and vas deferens. The typical sonographic changes after a vasectomy primarily include epididymal thickening and epididymal tubular ectasia with diminished blood flow in the epididymis. Spermatoceles display various sonographic findings, from multilocular cysts, to cystic lesions with low-echo levels, to a solid mass. Sperm granulomas appear as well-circumscribed heterogeneous masses on sonography and are commonly found at the epididymis or the ends of the severed vas deferens. The hydrocele, varicocele, epididymal cysts, and testicular cysts can also be associated; however, these findings are nonspecific. When radiologists encounter abnormalities of the scrotum, it would be useful to obtain a history of vasectomy to enable a correct diagnosis. Understanding of sonographic features of vasectomy-related changes and abnormalities is essential for correct diagnosis and proper management.

Early exploration in the management of acute scortum in children

Acute scrotal conditions are a common clinical setting that present with pain and swelling of the hemiscrotum. The aim of our study has been to evaluate the findings in boys operated on acute scrotum. A descriptive study was conducted on 100 patients with acute scrotum admitted to Mofid Children's Hospital from March 1993 to March 2007. Data included history, age, primary symptoms, definite diagnosis, side involvement, paraclinical tests, imaging modalities, medical or surgical management and type of the surgery. Diagnosis was made mainly by clinical signs and symptoms and surgical exploration. Torsion of testis [n=31] was the most common cause of acute scrotum followed by incarcerated inguinal hernia [n=30], torsion of testicular appendage [n=27], epididymo-orchitis [n=7], idiopathic scrotal edema [n=4] and hematocele [n=1]. Most [34%] of the patients were in the first year of life and the mean age was 5.4 years. The commonest signs were pain and swelling [62%] followed by pain, swelling and redness [21%] and pain alone [16%]. 83 patients consisting of 31 with torsion of testis, 14 with torsion of testicular appendage, 30 with incarcerated hernia and 7 with epididymo-orchitis underwent surgical exploration after careful physical examination. 10 of 31 patients with torsion of testis had orchiectomy and orchiopexy of contrea-lateral testis and the rest had detorsion and bilateral orchiopexy. 80% of patients were referred to the hospital after 12 hours of clinical onset of symptoms. Early exploration of scrotum based on careful physical examination excludes the risk of misdiagnosis by diagnostic procedures and unnecessary delay by diagnostic techniques. Exploration of scrotum is a relatively safe and simple procedure with good cosmetic results, it also allows an accurate diagnosis to be made

Results of ultrasound findings in cases of pure cystic scrotal swellings in patients of all ages in ash

To describe the results of ultrasound findings in pure cystic scrotal swellings in patients of all ages in ASH. It was a descriptive case series carriedout from Jan 2003 to Dec 2005 in SOPD and Surgical unit-1, Abbasi Shaheed Hospital and KMDC, Karachi. A total of 100 patients were taken who had pure scrotal swellings which were cystic in nature clinical examinations. These patients were treated in this hospital during this period. All patients [n=100] attending SOPD of Abbasi Shaheed Hospital with presenting complain of pure scrotal swellings were clinically examined with especial attention to get above the swelling, fluctuation and transillumination test and their size of the swelling also noted by an inch tape. An inform consent was taken and ultrasound of scrotum was done in ultrasound department to confirm the cystic swelling of scrotum and also to measure the size of the swelling. These patients were then divided into three groups according to the size of the scrotal swelling in which Group A [n=22] patients had size <5cm in diameter, Group B [n=51] had size 05-10cm in diameter and Group C [n=27] had size >10cm in diameter. All patients were admitted for surgery [exploration of the scrotal swelling]. On exploration of the scrotum [n=100], about 39% [n=39] of patients had < 50 ml of fluid, 32% [n=32] of patients had 50-100 ml of fluid while 29% [n=29] of patients had >100 ml of fluid in the sac. About 77% [n=77] of patients had clear amber coloured fluid, about 13% [n=13] had serous fluid with calcifications, about 07% [n=07] had pussy fluid and only 03% [n=03] had bloody fluid in the sac. Therefore about 90% of the patients had hydrocele [n=90], about 07% had pyocele [n=07] and only 03% of patients had haematocele [n=03]. No malignancy was found in this study. Most of the patients coming in this hospital with pure cystic scrotal swellings had hydroceles [90%], some of the patients had pyoceles [07%] while few had haematoceles [03%]. All most all cystic scrotal swellings were benign in nature and no malignancy was found in this study

Rupture of the Testes From Blunt Trauma

Background: Traumatic rupture of the testis is rare. Methods: Two patients with the condition are discussed in this article. The first; a 32 year old father; presented with post traumatic swelling and pain in the scrotum. He was a passenger on a motorcycle which was hit by a car. He was thrown up and landed on the windscreen of the car. He complained of pain in the scrotum and was quickly taken to a near-by clinic where a scrotal laceration was sutured. He continued to have severe pain from the swollen testes and was transferred to another clinic for urological attention. The second patient; a 26 year old man; was hit on the scrotum with a police handcuff. He presented with lower abdominal pain; scrotal and left testicular swellings. Results: The scrotum was explored in each patient. In the 32 year-old; the two testes ruptured transversely but were viable. Each was debrided and closed with chromic catgut. The patient was commenced on antibiotics. The following morning; the testes were much less swollen. The wound healed primarily in one week. At three weeks after injury; he claimed to have satisfactory erections but declined investigation of semen analysis as well as serum testosterone. In the 26 year old; exploration revealed a transverse rupture of the left testis. This was sutured. The wounds healed primarily. Conclusion: It is suggested that blunt trauma resulting in testicular swelling indicates testicular exploration and ultra sound investigation for diagnosis may not be necessary

Idiopathic chronic hematocele of the vaginal sac

We report a 39-year-old male who presented non-traumatic testicular swelling and pain. Physical examination and sonography presented a suspicion of testicular tumor and both surgical exploration and inguinal orchiectomy were performed. Hematocele may both clinically and sonographically resemble a testicular tumor. The diagnostic study of choice is magnetic resonance, establishing the diagnosis and differentiating it from neoplasms.

Clinical application of laparoscopic spleen-preserving operation in traumatic spleen rupture / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the effect of laparoscopic spleen-preserving operation for traumatic spleen rupture.</p><p><b>METHODS</b>From 1997 to 2003, 15 cases of traumatic spleen rupture were treated with laparoscopic spleen-preserving operation in our hospital. Nine cases had operation history in the middle and lower abdomen. ZT binding, electrocoagulation, fibrin and gelfoam tamping and suture repairing were used in patients with spleen rupture of grade I and grade II. Combined hemostasis was used for spleen rupture of grade III.</p><p><b>RESULTS</b>All patients did not need laparotomy during operation and no postoperative bleeding occurred. They were all cured and followed up for 3-12 months. Determination of immunoglobulins after operation showed normal, and spleen ultrasonic examination, CT and body state evaluations were all satisfactory.</p><p><b>CONCLUSIONS</b>Laparoscopy in the management of spleen trauma can be used in confirmed diagnosis and in determining the degree of spleen injury. For patients with stable vital signs laparoscopic spleen-preserving operation can be used. The laparoscopic spleen-preserving operation is safe in the treatment of traumatic spleen rupture.</p>

Three-dimensional fast field sequence magnetic resonance imaging of the scrotal lesions: is there a role for MRI?

Over the last 2 years, 25 patients with testicular masses detected at clinical examination or US underwent MR imaging, in addition to US. The findings of US and MR were compared. Imaging findings were correlated with the surgical and histopathologic findings. Finally, all MR examinations were retrospectively reviewed after the diagnosis was confirmed. The results showed that four patients were found to have extratesticular lesions and 21 patients intratesticular abnormalities. The extratesticular abnormalities included one case of simple hydrocele, one case of chronic hematocele, one case of infected hematocele with epididymo-orchitis and one case with tumor. The intratesticular abnormalities included malignant tumors [17 patients] and chronic inflammatory disease [4 patients]. Of the 17 patients with malignant tumors, 16 patients were primary and 1 patient with metastasis from Hodgkins disease. Of the 16 primary tumors, 11 patients had seminoma and 5 had non-seminomatous tumors [2 patients with teratoma, 1 patient with embryonal cell carcinoma and 2 patients with mixed germ cell origin]

Significance of Scrotal Ultrasonography on Blunt Scrotal Trauma

BACKGROUND: Testicular rupture is a surgical emergency which command immediate repair. If surgery is delayed, a hematoma causes severe pain and loss of spermatogenesis as well as hormonal functions. Scrotal ultrasonography has been helpful in early diagnosis of testicular rupture. But disadvantage of ultrasonography include a relatively low signal-to-noise level, tissue nonspecificity, lack of contrast media, a small field of view, and dependence on the operators skill and the patients physique. Also the diagnostic accuracy, sensitivity or specificity of scrotal ultrasonography was variable in regard to authors. And so, a diagnostic accuracy of scrotal ultrasonography was evaluated in scrotal trauma. METHODS: We reviewed 38 patients of scrotal trauma from May, 1994 to March, 1998. 6 patients were treated conservatively following scrotal sonography and 10 patients treated only surgical exploration without ultrasonography. Surgical exploration was performed in 22 case, which were evaluated by ultrasound before surgical treatment. In a such 22 cases, diagnostic accuracy of scrotal ultrasonography was evaluated. RESULTS: We compared ultrasound before treatment with surgical exploration finding in a such 22 cases. The ultrasonographic features in 7(31.8%) out of 22 cases, which showed testicular ruptured, but surgical exploration revealed testicular rupture in 5 and epididymal rupture in 1, simple hematocele in 1. In 15(68.2%) out of 22 cases the simple hematocele was diagnosed by ultrasonography, but surgical finding feature in of the 7 cases revealed testicular rupture, epididymal rupture in 1, simple hematocele in 7. The sensitivity and specificity for the ultrasonography are 42.9% and 87.5%, and the positive and negative predictive values are 86.5% and 46.7%, respectively. Ultrasonography is low sensitive in identifying testicular rupture. CONCLUSION: Ultrasonography include a relatively low signal-to-noise level, tissue nonspecificity, lack of contrast media, a small field of view, and dependence on the operators skill and the patients physique. Therefore, early surgical exploration for saving the testis should be performed that sonographically by seeing hypoehoic peripheral lesions and disappearance of normal ovoid form of testis, hematocele in scrotal sac.

Pulmonary Hematocele Mimicking Posterior Mediastinal Mass: Two Cases Report

Closed chest trauma occasionally results in the development of traumatic lung cyst or pulmonary hematocele.Radiologically, this latter rarely mimicks posterior mediastinal mass, which can cause unnecessary surgicalresection, We encountered two cases of pulmonary hematocele simulating posterior mediastinal mass. Multiplicity ofthe lesion, fracture of surrounding bony structure, decrease of mass size at follow-up examination, an acute anglebetween the mass and chest wall, peripheral rim enhancement of the mass, as seen on CT scans, or characteristicsignal intensity suggesting hematoma, as seen on MR images, helped differentiate pulmonary hematocele fromposterior mediastinal mass.

Role of Ultrasonography in diagnosis of acute scrotal lesions

Increasing attention has been directed to ultrasound role in evaluation of pathology of superficial organs such as the scrotum. The aim of this work is to highlight the increasing role of ultrasonography in diagnosis of acute scrotal lesions. The study was prformed on 50 patients. The apparatus used a real time, high resolution 5 MHz probe. Five cases of pyocele, 10 haematocele, 15 acute epididymitis, 16 orchitis, 2 testicular traumatic rupture and infarction and 2 testicular torsion were encountered. We conclude by saying that scrotal sonography provides rapid sensitive modality for evaluation of acute scrotal lesions

The Role of Ultrasonography in Identifying Testicular Rupture after Blunt Scrotal Trauma / 대한비뇨기과학회지

To determine the value of ultrasonography for the diagnosis of testicular rapture due to blunt trauma, we reviewed 69 patients of blunt scrotal trauma, which were evaluated by ultrasound before treatment. Thirty patients were managed conservatively, of which 3 cases were explored lately due to persistent pain or mass, and 39 explored immediately. Of the 30 patients treated conservatively the injury was resolved in 27. Surgical exploration of the 42 cases revealed testicular rupture in 29 and simple hematocele in 13. Analysis of the 29 cases with testicular rupture demonstrated that orchiectomy rates were 20% in early exploration and 53% in delayed exploration. in the 27 cases the testicular rupture was correctly diagnosed by ultrasonography, and there were 4 false-positive and 2 false-negative diagnoses of rupture. The specificity and sensitivity for the diagnosis of testicular rupture are 70% and 93%, and the positive and negative predictive values are 87% and 82%, respectively. Ultrasonography used in conjunction with a thorough physical examination is highly sensitive in identifying testicular rupture, and can provide objective information supporting the need for early surgical exploration in patients with blunt scrotal trauma.

Importance of Early Exploration in Blunt Scrotal Trauma / 대한비뇨기과학회지

Early diagnosis and prompt surgical exploration in blunt scrotal trauma is mandatory to save the affected testis and decrease the morbidity. We reviewed 25 cases of blunt scrotal trauma evaluated with ultrasonography as a result of violence, sports, traffic accident from March, 1989 to February, 1997. The right side was affected slightly more often than the left side. Sonography identified scrotal hematocele in 21 out of 25 cases and 4 cases had no evidence of scrotal hematocele. In 7 out of 21 cases with scrotal hematocele, ultrasonography showed rupture sites of the tunica albuginea (5) and intratesticular radiolucency displacing the normal echogenicity of the testicular parenchyina (2). In the other 14 cases ultrasonography showed no evidence of rupture. In 4 cases without scrotal hematocele, one was diagnosed as traumatic orchitis due to testicular enlargement and two had focal intratesticular hematoma so that these cases didn't undergo explorations. And 1 case had rupture of the tonics albuginea combined with testicular torsion at the time of exploration. Surgical explorations were performed in 19 (76.0%) out of 25 cases, who showed definitive rupture sites of the tunica albiginea (8), large hematoma and/or persistent severe pain without being seen rupture sites of the tunica albuginea (11) on ultrasonography and their operative methods were orchiectomy in 9 (36.0%), evacuation of the hematocele in 6 (24%), partial orchiectomy in 2 (8.0%) and simple closure of the tunica in 2 cases (8.0%). There was a direct relationship between salvageability and early surgery. In 13 out of 19 cases who underwent explorations within 3 days after trauma, the surgical managements comprised evacuation of the hematocele in 5 (38.5%), orchiectomy in 4 (30.8%), partial orchiectomy in 2 (15.4%), and simple closure of the tunica in 2 cases (IS.4%). However, in 6 cases who underwent explorations 4 days later after trauma, the surgical managements comprised orchiectomy in 5 (83.3%) and evacuation of the hematoma in 1 case (16.7%). In comparison with operative findings, 5 of the 14 cases, in which ultrasonography showed large hematocele without rupture of the tunica, had rupture of the tunica. Also, 7 cases, in which ultrasonography showed rupture of the tunica, all had rupture of the tonics. All patients with a history of blunt scrotal trauma, followed by a large hematocele without lure of the tunica or severely distorted testis on ultrasonography should have early surgical exploration to exclude injury to the testicle. A delayed treatment decreases the salvage rate due complications, such as ischemic necrosis and severe inflammatory reaction.

The Role of Ultrasonography in Blunt Testicular Trauma / 대한비뇨기과학회지

The ultrasonographic features in 26 cases of blunt testicular trauma were reviewed. Ultrasonography diagnosed correctly in 11 surgically proven cases of testicular rupture. There were three false-positive cases, two with a large scrotal hematocele and one with epididymis rupture. there were no false-negative cases. The sensitivity and specificity of ultrasonographic diagnosis were 100% and 80% respectively. The positive and negative predictive values were 78. 6% and 100% respectively. Therefore, the negative diagnosis by ultrasonography can warrant conservative therapy.

Quiste hemático de la orbita / The hematic cyst of the orbit

El quiste hemático es relativamente infrecuente. Su origen no es claro, pero ha sido descrito en asociación con trauma directo de órbita, hemorragia espontánea, discrasia sanguínea, linfangioma y hemorragioma cavernoso. Puede presentarse en cualquier grupo etáreo. Se reporta un caso de quiste hemático de órbita izquierda, sin antecedente traumático que clínicamente se diagnosticó como mucocele frontal izquierdo, describiéndose su tratamiento quirúrgico y el material histopatológico que concluye al diagnóstico definitivo

Conventional Ultrasonographic Examination of Scrotal Lesion / 대한비뇨기과학회지

Ultrasound has been shown to be effective in the diagnosis of a variety of scrotal abnormalities. We performed ultrasound of the scrotum in 22 patients with conventional 3.75 MHz real time scanner. There were 6 intratesticular lesions-3 spermatic cord torsion, 1 malignant lymphoma,1 leukemic infiltration and l yolk sac tumor. Extratesticular abnormalities included acute epididymitis, chronic epididymitis, Tb epididymitis, epididymal cyst peritesticular abscess, spermatocele, hematocele and infected hydrocele. Sonography accurately distinguished between testicular and extratesticular masses in all cases and pathologic correlation were obtained for operated scrotal lesions. The results were as follows. l. Out of 22 patients, chief complaints of 9 were acute sctotum and 13 were scrotal mass. 2. Of 9 cases with acute scrotum, ultrasonography detected 5 cases with acute epididymitis, 3 cases with spermatic cord torsion and l case with hematocele. 3. Of 13 cases with scrotal mass, surgical exploration was done in 1O cases. 9 cases were confirmed same as post-operative finding (90% accuracy). One case with hematoma was confirmed to infected hydrocele after operation. 4. Ultrasound characteristics of 22 patients were classified as follows. 13 were hypoechoic, 4 were anechoic, 3 were mixed and 2 were hyperechoic.

Scrotal spleen: review of literature and study of two cases

Splenic tissue within the scrotum, a rather rare condition, could be a diagnostic problem necessitating exploration of the testis.The literature was briefly reviewed and some manifestations of the lesion were presented with a study of clinical and pathological features of two new cases with this peculiar congenital anomaly

A Clinical Observation on Injuries of External Genitalia / 대한비뇨기과학회지

A clinical observation was made on 27 cases of injuries of external genitalia of the in-patient in the department of uro1ogy, Capital Armed Forces General Hospital during the period from January. 1977 to December, 1978. The results were as follows: 1) The rate of genitourinary injuries accounted for 19.5 per cent to the total admission patients during Z years. Twenty-nine per cent of all injuries were in patients with injuries of externa1 genitalia and they accounted for 5. 7 per cent to the total admission. 2) Most favorable age was in from 20 to 30 years for 96 per cent. 3) Kick or blow was the most frequent cause of the injuries (66.7%) and the next iatrogenic. Straddle fa11, automobile accident. gun shot and suicidal attempt were listed not less frequently. 4) Majority of injuries of external genitalia involved scrotum and testes. 5) 5cases (18.5%) of injuries of external genitalia were associated with injuries of other organs, especially with urethral injuries in 3 cases. 6) Surgical treatment was done on 20 of 27 cases of injuries of external genitalia and conservative treatment was done on others. In all scrotal explorations, drainage and compression dressing were utilized. These were resulted in a decrease of edema and hematoma formation. 7) Complications, such as chronic nonspecific epididymitis, hydrocele or hematocele etc., resulted from conservative treatment that had been done in 5 (75%) of 7 cases.