The utility of diffusion-weighted imaging and ADC values in the characterization of mumps orchitis and seminoma.

BACKGROUND: Diffusion-weighted imaging (DWI) can quantitatively reflect the diffusion characteristics of tissues, providing a theoretical basis for qualitative diagnosis and quantitative analysis of a disease. PURPOSE: To characterize testicular lesions that present as a hypointense signal on magnetic resonance imaging (MRI) T2-weighted images using DWI. MATERIAL AND METHODS: Study participants were divided into three groups. Group A were healthy controls (n = 35), group B included patients with mumps orchitis (n = 20), and group C included patients with seminoma (n = 15). DWI sequences used b-values of 0, 1000, and 2000 s/mm2. Apparent diffusion coefficient (ADC) values between 1000 and 2000 s/mm2 were calculated by MRI postprocessing software. The Kruskal-Wallis test and receiver operating characteristic analysis were performed to evaluate how well ADC values distinguished between mumps orchitis and seminoma. RESULTS: Normal testicular tissue showed a hyperintense signal on DWI and hypointensity on the ADC map: mean ADC value was 0.77 (0.69-0.85) ± 0.08 ×10-3 mm2/s. Mumps orchitis and seminoma showed slight hyperintensity on DWI: mean ADC values were 0.85 (0.71-0.99) ± 0.15 ×10-3 mm2/s and 0.43 (0.39-0.47) ± 0.04 × 10-3 mm2/s, respectively. There were statistically significant differences in mean ADC values between normal testicular tissue and seminoma and between mumps orchitis and seminoma. The cutoff ADC value for differentiating seminoma from mumps orchitis was 0.54 × 10-3 mm2/s. The sensitivity, specificity, and Youden Index for diagnosing seminoma were 99%, 31%, and 30%, respectively. CONCLUSION: High b-value DWI has potential utility for differentiating mumps orchitis from seminoma in the clinical setting.

A case of mumps-related acute encephalopathy with biphasic seizures and late reduced diffusion.

BACKGROUND: Mumps is a common childhood viral disease characterized by fever and swelling of the parotid gland. The prognosis is generally good, although some complications, such as encephalitis (0.1%), exist. Acute encephalopathy with biphasic seizures and late reduced diffusion is the most common type of acute encephalopathy. However, this type of encephalopathy has not been reported in association with mumps infection. PATIENT: A previously healthy 3-year-old Japanese boy had a brief convulsion after fever for 3days, and then had conscious disturbance and parotitis. After several days, he had a second brief convulsion and was admitted. Increased serum amylase levels and presence of anti-mumps immunoglobulin M antibody confirmed mumps parotitis. The patient had another brief seizure later the day of admission. He did not have status or cluster seizures, although the biphasic nature of his seizures, conscious disturbance between the seizures, no pleocytosis in cerebrospinal fluid, and brain magnetic resonance images were consistent with acute encephalopathy with biphasic seizures and late reduced diffusion. DISCUSSION: In Japan, the mumps vaccine is not administered as a part of routine immunizations. It thus has low coverage (30-40%), and as a result, mumps infections are still common. However, this is the first case of mumps-related acute encephalopathy with biphasic seizures and late reduced diffusion. This case may be representative of only a minority of patients with mumps-associated central nervous system involvement. Nevertheless, this diagnostic possibility may be considered. In order to prevent mumps-related complications, routine mumps vaccination might be warranted.

Mumps encephalitis with akinesia and mutism.

Measles-rubella-mumps vaccination is routine in many countries, but the mumps vaccine remains voluntary and is not covered by insurance in Japan. A 5-year-old Japanese boy who had not received the mumps vaccine was affected by mumps parotitis. Several days later, he presented with various neurological abnormalities, including akinesia, mutism, dysphagia, and uncontrolled respiratory disorder. Mumps encephalitis was diagnosed. Despite steroid pulse and immunoglobulin treatment, the disease progressed. Magnetic resonance imaging showed necrotic changes in bilateral basal ganglia, midbrain, and hypothalamus. At 1 year follow up, he was bedridden and required enteral feeding through a gastric fistula and tracheostomy. Mumps vaccination should be made routine as soon as possible in Japan, because mumps encephalitis carries the risk of severe sequelae.

Mumps virus-associated acute encephalopathy: case report and review of the literature.

We describe a fatal case of mumps virus-associated acute encephalopathy. In terms of the clinical course and cytokine as well as chemokine profiles, the pathogenesis in our case was different from that of mumps meningoencephalitis but was similar to that of influenza virus-associated acute encephalopathy.

[Its not always due to mumps!]. / Nicht immer ist der Ziegenpeter schuld!

A painless swelling of the parotid gland with non-specific symptoms and uncharacteristic blood values is not necessarily caused by mumps. On the contrary, this should be examined with targeted imaging, conventional X-rays of the thorax on two levels and for further differential diagnostic clarification, computed tomography of the thorax in order to search for further causes.

Mumps virus infection in adults: three cases of supraglottic edema.

Mumps virus infections primarily involve the parotid glands and most frequently affect school-aged children. We present three unusual adult cases of mumps with dyspnea secondary to severe swelling of the salivary glands and review previously reported cases in the literature. Dyspnea developed progressively after the onset of salivary gland swelling. Laryngoscopy revealed an advanced edematous change in the supraglottis obstructing the airway. In two cases, tracheotomy was needed because of rapid worsening of the supraglottic edema. Questioning regarding breathing problems and laryngoscopic examination is therefore recommended when one encounters a mumps case with combined parotid and salivary gland swelling.

[Functional changes and structural features of the testis in patients after acute parotid orchitis]. / Funktsional'nye izmeneniia i strukturnye osobennosti polovykh zhelez u patsientov, perenesshikh ostryi parotitnyi orkhit.

Structural changes and functional features of the testes were studied in 20 patients who had had parotid orchitis (PO) 6 months to 1.5 years before the study. The examination including ultrasonography of the testes, investigation of ejaculate, radioimmunoassay for serum testosterone, FSH, LH brought out a significant reduction of the mean volume and echogenicity of the affected testicles by 44.7 and 50%, respectively, in 15 patients; a 58.2% decrease in the number of spermatozoa in ml; a 71.2% rise in FSH level in 6 patients. Morphometry of biopsy specimen of the testicles on the affected side has shown that mean sectional area of the tubules has diminished by 40%, the spermatogenesis index--by 77.1% while the volume of the intertubular connective tissue increased by 47.7%. Thus, after acute PO, the patients develop atrophic changes in the testes and a decline in spermatogenic function up to secretory infertility.

Mumps epididymo-orchitis: sonography and color Doppler sonographic findings.

Eleven cases of mumps epididymo-orchitis were examined by gray-scale and color Doppler ultrasonography. Nine cases were unilateral and two were bilateral. In the initial examination, the volume and the vascularity of the affected testis and epididymis and the thickness of the scrotal wall was greater than of the normal site, whereas the testicular echogenicity was decreased homogenously, resistivity indexes of intratesticular arteries were decreased, and spontaneous venous flow was seen in all cases. In contrast to nonspecific epididymo-orchitis, no hydrocele was seen, but minimal reactive hydrocele was found in two cases. The diagnosis was confirmed by specific immunoglobulin-G examination. Patients were given interferon and were controlled by ultrasonography and Doppler ultrasonography at the third and seventh days of treatment and 3 months after treatment. Sonographic findings began to improve by the third day and fully disappeared in seventh day. No testicular atrophy was seen in the last control. To our knowledge, this is the first report on sonographic and color Doppler sonographic findings of mumps epididymo-orchitis.

MRI of mumps encephalitis: comparison with CT evaluation.

The evaluation of a patient with mumps encephalitis by computed tomography (CT) and magnetic resonance (MR) imaging is reported. Correlation of findings on MR and CT in relation to clinical symptoms is presented. MR was found to be more sensitive in the number of lesions detected (11) as compared to CT (3). Thus, it seems that MR imaging may be a sensitive diagnostic adjunct in cases of suspected viral encephalitis.

[The significance of sialography in tumors of the parotid gland (author's transl)]. / Der Wert der Sialographie bei Parotistumoren.

The significance of sialography in diagnosis of parotid gland tumors is based on the differentiation of chronic inflammatory, benign and malignant lesions. This method combined with history and physical findings will establish the diagnosis in 80% of cases with parotid gland tumors. Water-soluble contrast media are most useful for ductography. It provides good contrast, stays in the duct system for a sufficient period of time and will not cause inconvenience to the patient. Tomograms are particularly valuable in addition to the standard a.p. and lateral standard views. Chronic inflammation causes alterations with small paraductal contrast accumulations throughout the entire efferent duct system. Benign tumors may be recognized by straight ducts and interlobular paravasates. In malignant neoplasms filling defects are more characteristic than parenchymal staining. Peracute and subacute inflammations as well as tuberculosis are difficult to diagnose by sialography.