Testicular microlithiasis: association with male infertility.

PURPOSE: We studied the frequency of testicular microlithiasis (TM) in a select group of otherwise healthy infertile men with abnormal semen. METHODS: We reviewed scrotal sonography records of 180 consecutive patients with abnormal semen who were referred for evaluation of male infertility. The pampiniform plexus was evaluated for possible varicocele, and the testes were examined for the presence or absence of intratesticular calcifications and/or masses. Five patients with more than 5 echogenic foci per transducer field in either testis were identified. The medical records and sonograms of this subgroup of patients were analyzed. RESULTS: Of the 180 patients, 5 (2.8%) had TM. Three patients with TM had concomitant small varicoceles; 2 others had a history of testicular maldescent. Two patients eventually became fertile. CONCLUSIONS: Our results indicate a higher than expected frequency of TM in otherwise healthy infertile men. We speculate that the magnitude of hypospermatogenesis in patients with TM is variable and may relate to both the degree of testicular dysgenesis and the presence or absence of concomitant scrotal pathology (eg, scrotal varicocele and cryptorchidism).

Klinefelter's syndrome associated with testicular microlithiasis and mediastinal germ-cell neoplasm.

Klinefelter's syndrome is a genetic disorder of male sexual differentiation characterized by an XXY karyotype. Although considered a benign condition, it is associated with several types of malignancies, including mediastinal germ-cell neoplasm. In addition, Klinefelter's syndrome has been rarely associated with testicular microlithiasis. Whereas patients with Klinefelter's syndrome have an increased incidence of extragonadal germ-cell neoplasms, patients with testicular microlithiasis have a predisposition to testicular germ-cell neoplasms. To our knowledge, an extragonadal germ-cell neoplasm has not been previously described in association with testicular microlithiasis. We present a patient with 2 unusual conditions, both of which are independently associated with Klinefelter's syndrome: mediastinal germ-cell neoplasm and testicular microlithiasis.

Gastric involvement in Waldenstrom macroglobulinemia: CT findings.

Waldenstrom macroglobulinemia is a plasma cell dyscrasia that rarely presents with gastrointestinal involvement. We report a case of gastric involvement of Waldenstrom macroglobulinemia detected by CT.

The perinephric space and renal fascia: review of normal anatomy, pathology, and pathways of disease spread.

The perinephric space is a cone-shaped retroperitoneal compartment containing the kidney, adrenal gland, perinephric fat, fibrous bridging septa, and a rich network of perirenal vessel and lymphatics. Perinephric space pathology may originate from within or outside the confines of the perirenal fascia. Most intrinsic perinephric space disease arises from the kidney or adrenal gland, and secondarily involves the perinephric space. Disease originating outside the cone of renal fascia may spread to the perinephric space via lymphatics (i.e., metastatic spread) or by directly transgressing perirenal fascial planes (e.g., invasive tumor or infections). Additionally, infiltrating soft tissue or rapidly accumulating retroperitoneal fluid may travel into or out of the perinephric space via perinephric bridging septa and renal fascia. In this article, we review the normal anatomy of the perinephric space and renal fascia, emphasizing the significance of retroperitoneal interfascial planes and perinephric bridging septa as a potential conduit for retroperitoneal disease spread. This review of normal anatomy and pathways of disease spread serves as background for a discussion of a variety of specific pathologic conditions that may involve the perinephric space and retroperitoneal fascia, including pancreatitis, retroperitoneal hematoma, urinoma, metastatic disease, and perirenal varices.

Carcinoma of the gallbladder: color Doppler ultrasound and CT findings.

A case of a large polypoidal gallbladder carcinoma presenting with empyema is described. Heterogeneous echoes filled the gallbladder lumen on gray-scale sonography. Color Doppler ultrasound detected vascularity within the gallbladder lumen, thereby differentiating the intraluminal tumor from isoechoic sludge and pus. Correlative computed tomography showed an enhancing intraluminal mass, with small enhancing vessels that corresponded to those seen with color Doppler sonography.

Subcutaneous splenosis.

Splenosis is the ectopic implantation of splenic tissue, usually as the result of trauma. Intraperitoneal, intrathoracic, and retroperitoneal sites of implantation have been reported. The authors report a case of subcutaneous splenosis involving the abdominal wall that was imaged with CT and scintigraphy.

Intrasplenic venous thrombosis: CT findings.

OBJECTIVE: To describe the CT findings of intrasplenic venous thrombosis in three cases. MATERIALS AND METHODS: Three adult patients had abdominal CT indicative of short-segment thrombosis of an intrasplenic blood vessel. Two patients underwent splenectomy; thrombosis of a segmental splenic vein was confirmed histologically in both cases. RESULTS: Segmental splenic vein thrombosis appeared on CT as a short, 1-2 cm, linear lucency surrounded by normal splenic parenchyma. The probable etiology of intrasplenic venous thrombosis was main splenic vein occlusion related to pancreatitis in two cases and splenic compression and inflammation by perisplenic abscess in the third case. CONCLUSION: Thrombosis of segmental intrasplenic veins is detectable with CT and can be a secondary CT finding of main splenic vein thrombosis.

Chylous ascites: CT and ultrasound appearance.

An unusual but pathognomonic appearance of chylous ascites was observed on computed tomographic (CT) and ultrasound examinations of the abdomen in a patient with AIDS and disseminated tuberculosis. The images showed gradual development of fat-fluid level in the peritoneal collection when the patient maintained a recumbent position. The explanation for this phenomenon is provided together with a brief review of pertinent literature.

Perforated jejunal diverticulum: CT diagnosis.

A case of a perforated jejunal diverticulum with retroperitoneal extension is presented. Computed tomographic (CT) features and the plain radiographic appearance are described in this rare complication of a common pathologic finding.

Imaging findings of adult Bochdalek hernias.

The purpose of this article is to review the computed tomographic (CT) and related radiographic findings of adult Bochdalek hernias. Bochdalek hernias are one of the most common congenital abnormalities encountered in imaging studies of the chest and abdomen. CT can be used to confidently diagnose Bochdalek hernias, which can easily mimic neoplasms on other imaging studies.

Hemorrhagic ovarian cysts in patients on anticoagulation therapy: CT findings.

OBJECTIVE: Hemorrhage into ovarian cysts is a frequent and potentially life-threatening complication in women on chronic anticoagulation therapy. This article presents the CT findings of three surgically confirmed cases of symptomatic hemorrhagic ovarian cysts associated with anticoagulation therapy. MATERIALS AND METHODS: There were two cases of unruptured hemorrhagic ovarian cysts: a patient with two corpus luteum cysts of menstruation and a patient with a serous cystadenoma. RESULTS: Each mass had a rounded central region of high attenuation (76, 62, and 50 HU) representing blood that was surrounded by fluid density. The third case was a hemorrhagic corpus luteum cyst of menstruation with rupture and hemoperitoneum. CONCLUSION: Hemorrhagic ovarian cysts should be included in the differential diagnosis of high-attenuation adnexal masses, especially in patients on anticoagulation therapy and in those with abrupt onset of pelvic pain.

Complications after laparoscopic cholecystectomy: imaging findings.

Laparoscopic cholecystectomy is rapidly becoming an acceptable alternative to traditional open cholecystectomy. Laparoscopic procedures are associated with shortened recovery periods and hospital stays and the cosmetic benefit of smaller scars. Early results from laparoscopic cholecystectomies suggested a high rate of complications; however, recent studies have shown that, in experienced hands, the complication rates of open and laparoscopic procedures are comparable. Complications differ somewhat between the two types of operations. In laparoscopic cholecystectomy, complications are associated with virtually every aspect of the procedure. The purpose of this essay is to illustrate the imaging findings of the complications that occur in patients undergoing laparoscopic cholecystectomy.

Retrogastric colon: CT demonstration of anatomic variations.

In a series of 9,400 body computed tomographic (CT) scans of adult patients, a retrogastric course of the transverse colon with interposition of colon between the pancreatic body-tail and stomach was identified in 18 patients (0.2%). Three other patients (0.03%) had retrosplenic, retrogastric colon with transverse colon interposed between the spleen and posterior diaphragm. Three of the 18 patients with pancreaticogastric interposition also had small bowel malrotation. Clinically, no symptoms attributable to retrogastric colon were found. Retrogastric colons probably result from mild embryologic abnormalities of bowel rotation and fixation. Radiologically, colon in the area of the lesser sac must be differentiated from the normal duodenojejunal flexure, a perforated viscus, and abscess.

CT diagnosis of concurrent hematomas of the psoas muscle and rectus sheath: case reports and review of anatomy, pathogenesis, and imaging.

Two cases are presented in which psoas muscle and rectus sheath hematomas occurred concurrently. The case presentations are followed by a review of anatomy, pathogenesis, and imaging modalities involved in the cause and diagnosis of such hematomas.

Perirenal metastases from lung cancer: CT diagnosis.

Three patients with primary lung cancer had perirenal metastases detected with CT. In two cases a symptomatic perirenal mass was the first evidence of metastatic spread and CT-guided biopsy of the perirenal lesion confirmed the diagnosis of metastatic lung cancer. The perirenal space is an unusual but potentially significant site of metastasis from lung cancer as well as other tumors such as malignant melanoma. It is suggested that connections between perirenal and intrathoracic lymphatics are the most probable mechanism of this pattern of spread by lung cancers.

CT findings in tuboovarian abscess.

Pelvic inflammatory disease with tuboovarian abscess can cause a wide range of radiologic abnormalities. Although the diagnosis of tuboovarian abscess is usually straightforward and is based on clinical and sonographic findings, unusual or unsuspected cases may be confused with other pelvic or abdominal diseases. The purpose of this essay is to illustrate the CT findings in tuboovarian abscess.