1
|
Starostin D, Ibrahim M, Ahmed N. A case of post-HoLEP vasitis mimicking incarcerated inguinal hernia. A diagnostic approach. Radiol Case Rep 2024; 19:3122-3125. [PMID: 38770388 PMCID: PMC11103355 DOI: 10.1016/j.radcr.2024.04.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 04/05/2024] [Accepted: 04/19/2024] [Indexed: 05/22/2024] Open
Abstract
Vasitis is inflammation of the vas deferens, which can be divided into acute inflammatory vasitis or chronic vasitis nodosa. Acute vasitis can present with inguinal pain, swelling, or a lump, which could mimic other common pathologies occurring at this site, particularly inguinal hernia. While ultrasound is effective in the diagnosis of epididymitis, orchitis, and hernia, this case illustrates the importance of cross-sectional imaging to establish the correct diagnosis of vasitis, to aid in the prevention of unnecessary surgical exploration and to expedite antibiotic treatment. Previous surgical intervention to the prostate is the leading risk factor for vasitis and should be taken into consideration when making a differential diagnosis and determining which image modality to use. Here, we present a case of vasitis in a 60-year-old male with previous Holmium laser enucleation of the prostate (HoLEP), with an initial diagnosis of inguinal hernia on ultrasound which was later diagnosed as acute vasitis on CT.
Collapse
Affiliation(s)
| | - Mohamed Ibrahim
- Queen Elizabeth Hospital, Queen Elizabeth Ave, Gateshead NE9 6SX
| | - Nali Ahmed
- Rotherham General Hospital, Moorgate Rd, Rotherham S60 2UD
| |
Collapse
|
2
|
Shibuki S, Saida T, Hoshiai S, Ishiguro T, Sakai M, Amano T, Abe T, Yoshida M, Mori K, Nakajima T. Imaging findings in inflammatory disease of the genital organs. Jpn J Radiol 2024; 42:331-346. [PMID: 38165529 PMCID: PMC10980613 DOI: 10.1007/s11604-023-01518-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024]
Abstract
This review focuses on inflammatory diseases of female and male genital organs and discusses their epidemiology, pathogenesis, clinical presentation, and imaging findings. The female section covers pelvic inflammatory disease (PID) primarily caused by sexually transmitted infections (STIs) that affect the uterus, fallopian tubes, and ovaries. Unusual causes such as actinomycosis and tuberculosis have also been explored. The male section delves into infections affecting the vas deferens, epididymis, testes, prostate, and seminal vesicles. Uncommon causes such as tuberculosis, and Zinner syndrome have also been discussed. In addition, this review highlights other conditions that mimic male genital tract infections such as vasculitis, IgG4-related diseases, and sarcoidosis. Accurate diagnosis and appropriate management of these inflammatory diseases are essential for preventing serious complications and infertility. Imaging modalities such as ultrasound, magnetic resonance imaging, and computed tomography play a crucial role in diagnosis. Understanding the diverse etiologies and imaging findings is vital for the effective management of inflammatory diseases of the genital organs.
Collapse
Affiliation(s)
- Saki Shibuki
- Department of Radiology, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Tsukasa Saida
- Department of Radiology, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Sodai Hoshiai
- Department of Radiology, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Toshitaka Ishiguro
- Department of Radiology, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Masafumi Sakai
- Department of Radiology, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Taishi Amano
- Department of Radiology, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Tetsuya Abe
- Department of Radiology, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Miki Yoshida
- Department of Radiology, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Kensaku Mori
- Department of Radiology, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Takahito Nakajima
- Department of Radiology, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| |
Collapse
|
3
|
Al-Gburi S, Patel S. A Rare Case of Acute Vasitis. Cureus 2023; 15:e51337. [PMID: 38288181 PMCID: PMC10824465 DOI: 10.7759/cureus.51337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2023] [Indexed: 01/31/2024] Open
Abstract
Inflammation of the vas deferens, or vasitis, is a rarely reported condition that can manifest as either acutely painful infectious vasitis or predominantly asymptomatic vasitis nodosa. Acute vasitis is usually presented with ambiguous clinical findings, and a scan is required for a definitive diagnosis. Retrograde urinary pathogens are typically the cause, and it is treatable conservatively. We present a male in his 40s with a one-day history of right groin pain and a history of right indirect inguinal hernia. On examination, there was an impression of an incarcerated inguinal hernia. A CT scan revealed thickening and inflammatory changes associated with the inguinal canal and a picture of the rare inflammatory condition, acute vasitis. This case report illustrates the significance of understanding the wide range of possible diagnoses associated with acute groin pain and swelling and the importance of imaging in the diagnosis, which might help avoid needless operation.
Collapse
Affiliation(s)
- Saleh Al-Gburi
- Urology, Wirral University Teaching Hospitals, Wirral, GBR
| | - Snehal Patel
- Urology, Wirral University Teaching Hospitals, Wirral, GBR
| |
Collapse
|
4
|
McArthur M, Patel M. A pictorial review of genitourinary infections and inflammations. Clin Imaging 2023; 104:110013. [PMID: 37918136 DOI: 10.1016/j.clinimag.2023.110013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/03/2023] [Accepted: 10/23/2023] [Indexed: 11/04/2023]
Abstract
Various infectious and inflammatory diseases affect the genitourinary system. This paper provides a review of multiple common and uncommon infectious and inflammatory conditions affecting the genitourinary system and some associated complications. These include acute infectious cystitis, emphysematous cystitis, acute pyelonephritis, emphysematous pyelonephritis, renal and perinephric abscesses, pyonephrosis, xanthogranulomatous pyelonephritis, epididymo-orchitis, vasitis, prostatitis, pelvic inflammatory disease, renal hydatid infection, renal tuberculosis, actinomycosis, Erdheim-Chester Disease, IgG4-Related Kidney Disease, urethritis and urethral strictures, ureteritis cystica, and genitourinary fistulas. Radiologists should be aware of these diseases' complications and management. Uncommon conditions must be considered when evaluating the genitourinary system.
Collapse
Affiliation(s)
- Mark McArthur
- University of California, Los Angeles, United States.
| | | |
Collapse
|
5
|
Li YH, Huang ZM, Yu JK, Lin YS, Hsu CY, Tung MC. Misdiagnosis of vasitis: a potential diagnostic pitfall with computed tomography. Basic Clin Androl 2022; 32:19. [PMID: 36217112 PMCID: PMC9552416 DOI: 10.1186/s12610-022-00168-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 07/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background Vasitis is a rare condition that may be challenging for the clinical practitioner. Sometimes it is misdiagnosed as incarcerated inguinal hernia; thus, patients end up receiving unnecessary surgery. Compared with the traditional approach with only sonography, the more recent introduction of computed tomography in the diagnostic process has provided higher quality imaging and more detailed anatomy. Consequently, some urologists advocate the efficacy of computed tomography in the differential diagnosis of difficult cases. Case presentation We present the case of a 23-year-old male who suffered from right inguinal pain and swelling. His scrotum ultrasound showed multiple tubular structure dilatation within the subinguinal area and no testis torsion. The initial diagnosis was a right inguinal hernia. Computed tomography supported that initial diagnosis, and we presumed the lesion represented a herniation of the omentum with mesenteric vessels. Since there was a suspicion of hernia incarceration, the patient underwent diagnostic laparoscopy, which did not reveal herniation, but only erythematous reaction and swelling over the right spermatic cord. Following a final diagnosis of vasitis, he received empirical antibiotic treatment and his symptoms entirely resolved. Conclusions Even though computed tomography can provide thorough imaging of the urogenital system, the contrast enhancement within vessels and inflammatory organs can still be misleading in the diagnostic process.
Collapse
|
6
|
Kerr DM, Middleton WD. Ultrasound of the Normal and Abnormal Vas Deferens. Ultrasound Q 2022; 38:224-236. [PMID: 35129151 DOI: 10.1097/ruq.0000000000000588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The extrapelvic portion of the vas deferens is readily visible with ultrasound but often overlooked. Several publications have described the scanning technique and the normal anatomy of the vas deferens. Sonographic evaluation of the vas deferens provides critical information in the workup of male infertility. Obstruction, inflammatory conditions, and neoplasms of the vas deferens can also be diagnosed with ultrasound. Knowledge of the normal and abnormal appearance of the vas deferens improves scans of the scrotum and expands the conditions that can be recognized and accurately diagnosed with ultrasound.
Collapse
|
7
|
Almutairi M, Althubiany H, Alhabsi A, Fadaak K, Almuhaish M, Albalawi F. Acute Vasitis clinical picture mimicking inguinal hernia: Case report and review. Urol Case Rep 2021; 40:101847. [PMID: 34849345 PMCID: PMC8609150 DOI: 10.1016/j.eucr.2021.101847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 09/09/2021] [Indexed: 11/28/2022] Open
Abstract
Acute Vasitis a rare condition, but one that can present with a diagnostic dilemma, if not recognized and managed appropriately, may lead to unnecessary surgical interventions with consequent morbidity for the patient. A 27 year old healthy male, presented with left scrotal pain associated with inguinoscrotal swelling. Physical examination revealed left scrotum tenderness and swelling extended along left inguinal area. CT showed multi loculated cystic fluid collection within left seminal vesicle. Acute Vasitis is a rare differential diagnosis for acute scrotum and This case report summarizes the importance of identifying it and how imaging can prevent unnecessary surgical intervention.
Collapse
Affiliation(s)
- Mohammed Almutairi
- Department of Urology, Imam Abdulrahman Bin faisal University, Saudi Arabia
| | - Hatem Althubiany
- Department of Urology, Imam Abdulrahman Bin faisal University, Saudi Arabia
| | - Ahad Alhabsi
- Department of Urology, Imam Abdulrahman Bin faisal University, Saudi Arabia
| | - Kamel Fadaak
- Department of Urology, Imam Abdulrahman Bin faisal University, Saudi Arabia
| | - Mona Almuhaish
- Department of Radiology, Imam Abdulrahman Bin faisal University, Saudi Arabia
| | - Faisal Albalawi
- Department of Radiology, Imam Abdulrahman Bin faisal University, Saudi Arabia
| |
Collapse
|
8
|
Carlberg DJ, Lee R, Davis JE. Reproductive -Aged Man with Inguinal Pain. J Emerg Med 2021; 61:742-743. [PMID: 34756745 DOI: 10.1016/j.jemermed.2021.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/17/2021] [Accepted: 09/11/2021] [Indexed: 11/19/2022]
Affiliation(s)
- David J Carlberg
- Department of Emergency Medicine, Georgetown University and MedStar Health, Washington, District of Columbia
| | - Rebecca Lee
- Department of Emergency Medicine, Emory University, Atlanta, Georgia
| | - Jonathan E Davis
- Department of Emergency Medicine, Georgetown University and MedStar Health, Washington, District of Columbia
| |
Collapse
|
9
|
Jones A, Vazirian-Zadeh M, Phan YC, Mahmalji W. Post vasectomy chronic pain: are we under diagnosing vasitis? A case report and review of the literature. Aging Male 2020; 23:437-439. [PMID: 30270700 DOI: 10.1080/13685538.2018.1513481] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Acute vasitis is a rare infection of the vas deferens. Clinical presentation and disease rarity can cause difficulty in correctly diagnosing this condition. Adjuncts to aid diagnosis can be used that include ultrasound scan (USS) or computed tomography. We report a unique case of acute vasitis following vasectomy, reversal and subsequent re-do vasectomy diagnosed using USS.
Collapse
|
10
|
Matthews SJ, Tyson M, Lauti M, Zargar K. Sexually transmitted infective vasitis mimicking left inguinal hernia: computed tomography clarifies diagnosis. ANZ J Surg 2020; 90:2583-2584. [PMID: 32369670 DOI: 10.1111/ans.15957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 04/17/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Samuel J Matthews
- General Surgery, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Matthew Tyson
- Urology Department, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Melanie Lauti
- General Surgery, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Kamran Zargar
- Urology Department, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
| |
Collapse
|
11
|
Chen CW, Lee CH, Huang TY, Wang YM. Vasitis: a rare diagnosis mimicking inguinal hernia: a case report. BMC Urol 2019; 19:27. [PMID: 31035980 PMCID: PMC6489350 DOI: 10.1186/s12894-019-0460-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 04/12/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vasitis or inflammation of the vas deferens is a rare condition, and few case reports with computed tomography images have been published since 1980. CASE PRESENTATION A 50-year-old man presented with severe right inguinal and lower abdominal pain. Initial diagnosis at the emergency department was incarcerated or strangulated inguinal hernia. The computed tomography scan revealed diffuse edematous changes of right spermatic cord and vas deferens with peripheral fat stranding. Correlating with his clinical symptoms, signs, and imaging findings, the diagnosis of vasitis was made. We report a case of acute vasitis about the cause, symptom, pathogen, differential diagnoses, image findings, and treatment. CONCLUSION Although very rare, vasitis should be listed as one of the differential diagnosis for inguinal mass lesions. Cross-sectional imaging may be necessary to confirm the diagnosis and exclude differentials such as an inguinal hernia. Recognition of the characteristic image findings can help to make the correct diagnosis and avoid unnecessary surgery.
Collapse
Affiliation(s)
- Chih-Wei Chen
- Department of Radiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Ziyou 1st Rd., Sanmin District, Kaohsiung City, 80756, Taiwan, Republic of China
| | - Chin-Ho Lee
- Department of Radiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Ziyou 1st Rd., Sanmin District, Kaohsiung City, 80756, Taiwan, Republic of China
| | - Tsung-Yi Huang
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Yi-Ming Wang
- Department of Radiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Ziyou 1st Rd., Sanmin District, Kaohsiung City, 80756, Taiwan, Republic of China.
| |
Collapse
|
12
|
Ramanathan S, Palaniappan Y, Sheikh A, Ryan J, Kielar A. Crossing the canal: Looking beyond hernias — Spectrum of common, uncommon and atypical pathologies in the inguinal canal. Clin Imaging 2017; 42:7-18. [DOI: 10.1016/j.clinimag.2016.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 10/25/2016] [Accepted: 11/04/2016] [Indexed: 01/09/2023]
|
13
|
Abstract
Amyand’s hernia is an inguinal hernia containing the caecal appendix. Radiologically a tubular structure is found inside the inguinal canal. However, other conditions may show similar radiological findings. Anamnesis and physical examination are essential for an accurate diagnosis.
Introduction Amyand’s hernia is an inguinal hernia containing the caecal appendix. It is usually an intraoperative finding, although it can be diagnosed preoperatively with radiologic examinations, which would show a tubular structure inside the inguinal canal. Presentation of case A male patient presented to the emergency department complaining of abdominal pain in the right lower quadrant. He had been orchidectomized during his childhood due to cryptorchidism, and had been under antibiotic treatment a week before due to a suspected gonorrhoea. A small irreductible mass was found in the right groin. Blood tests showed leucocytosis and elevated CRP. A CT-scan was performed, reporting a tubular structure with a blind end entering the inguinal canal that seemed to be the appendix. Single-port laparoscopic exploration was indicated, and a right vasitis was found instead of an Amyand’s hernia. After the operation, the patient explained that he had not taken the antibiotics for the gonorrhoea. Discussion Untreated gonorrhoea causes ascendant vasitis and orchyepididimitis. In the present case, since the patient did not have testicles, the inflamed vas deferens mimicked the Appendix inside the inguinal canal. If the patient had told the truth about the untreated gonorrhoea, maybe the condition would have been suspected and no radiological examinations would have been performed, which subsequently lead to an unnecessary operation. Conclusion Presently, Amyand’s hernia is more frequently diagnosed preoperatively than intraoperatively. However when an Amyand’s hernia is preoperatively suspected, the possibility of a vasitis should always be ruled out in order to avoid unnecessary operations.
Collapse
|