EP.FRI.596 A Tale of Two Ultrasounds

Abstract Background Testicular torsion is a common cause of acute testicular pain, which requires immediate investigation and treatment. We describe a unique presentation of testicular torsion, which required the operating surgeon to assess the viability of a clinically dead testis through surgical manipulation, 16 hours after onset of pain. Case Report A 19 year old male presented with a 12 hour history of pain and swelling in the left scrotum. Examination revealed the left testes was hard, swollen and tender with a palpable spermatic cord. Clinical diagnosis of testicular mass or epididymo-orchitis was suggested and scrotal ultrasound was organised. This reported no blood flow in the left testis, and so torsion was suspected. Patient was taken immediately to theatre. Examination was performed under general anaesthetic, which revealed a hard, swollen testis, with no torsion clinically. Midline scrotal incision was made. On visual examination, left testis was black and hard, but there was no obvious torsion in the cord. However, during manipulation, the testis softened and started to change colour, eventually becoming dusky. A small incision into the testis showed bright red blood, and the decision was made to replace the testis and fix both testes. The patient made an excellent recovery post-operatively. Repeat ultrasound showed return of testicular vascularity. Conclusion This case showcases the importance of considering salvage in patients who have presented even after the generally accepted 6-8 hour time window. It also highlights the value of an experienced surgeon’s judgement in unusual presentations and with unexpected events intraoperatively.

Download Full-text

Leiomyosarcoma of the spermatic cord: case report and literature review

Canadian Urological Association Journal ◽

10.5489/cuaj.42 ◽

2012 ◽

Vol 1 (1) ◽

Author(s):

Pankaj Dangle ◽

Doddametikurke R. Basavaraj ◽

Selina Bhattarai ◽

Alan B. Paul ◽

Chandra Shekhar Biyani,

Keyword(s):

Case Report ◽

Literature Review ◽

Ct Scan ◽

Spermatic Cord ◽

Ct Scans ◽

Excision Biopsy ◽

Ultrasound Scan ◽

Left Testis ◽

Scrotal Ultrasound ◽

History Of

A 51-year-old man presented with a 2-year history of painless lump in the lefthemiscrotum. Scrotal examination demonstrated a 3-cm, firm-to-hard massattached to the left spermatic cord. Scrotal ultrasound scan revealed a heterogeneousmass separate from the left testis and epididymis. An orchidectomywas recommended to the patient; however, he declined surgery andunderwent excision biopsy of the lesion with preservation of the left testis.Histology suggested a leiomyosarcoma of the spermatic cord and positivemargins. Following a normal staging CT scan, the patient was referred tothe regional sarcoma clinic. He was treated with an orchidectomy. Microscopicexaminations showed fibrosis in the spermatic cord and negative margins.The patient has been followed up for 12 months with CT scans and shows nosigns of recurrence.

Download Full-text

Segmental Testicular Infarction, an Underdiagnosed Entity: Case Report with Histopathologic Correlation and Review of the Diagnostic Features

Case Reports in Radiology ◽

10.1155/2016/8741632 ◽

2016 ◽

Vol 2016 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Sahar Shiraj ◽

Nisha Ramani ◽

Andrij R. Wojtowycz

Keyword(s):

Diagnostic Features ◽

Left Testis ◽

Scrotal Pain ◽

Left Testicle ◽

Scrotal Ultrasound ◽

Testicular Infarction ◽

Segmental Infarction ◽

History Of ◽

Radical Orchiectomy ◽

Segmental Testicular Infarction

A 30-year-old male presented with a 1-day history of left scrotal pain and a tender left testicle and epididymis on physical exam. Scrotal ultrasound showed an avascular, heterogeneous, hypoechoic lesion in the superior left testis suggestive of infarction or neoplasm. The patient was managed conservatively; however, his pain continued and follow-up ultrasound 6 days later showed interval increase in the size of the mass. Left radical orchiectomy was done and pathology result showed segmental infarction of the left testis.

Download Full-text

The history of pain and hysteria

Neurorehabilitation ◽

10.1016/s1053-8135(96)00219-3 ◽

1997 ◽

Vol 8 (3) ◽

pp. 157-162 ◽

Cited By ~ 1

Author(s):

H Merskey

Keyword(s):

History Of ◽

History Of Pain

Download Full-text

Sacral plexus disorder caused by a wooden toothpick in the rectum

BMJ Case Reports ◽

10.1136/bcr-2020-238690 ◽

2021 ◽

Vol 14 (1) ◽

pp. e238690

Author(s):

Takuro Endo ◽

Taku Sugawara ◽

Naoki Higashiyama

Keyword(s):

Lower Limb ◽

Spinal Nerve ◽

Leg Pain ◽

Sacral Plexus ◽

Lateral Recess ◽

Lateral Recess Stenosis ◽

Preoperative Ct ◽

History Of ◽

History Of Pain ◽

The Right

A 67-year-old man presented with a 2-month history of pain in his right buttock and lower limb. MRI depicted right L5/S1 lateral recess stenosis requiring surgical treatment; however, preoperative CT showed an approximately 7 cm long, thin, rod-shaped structure in the rectum, which was ultimately determined to be an accidentally ingested toothpick. It was removed surgically 6 days after diagnosis, because right leg pain worsened rapidly. The pain disappeared thereafter, and the symptoms have not recurred since. The pain might have been localised to the right buttock and posterior thigh in the early stages because the fine tip of the toothpick was positioned to the right of the anterior ramus of the S2 spinal nerve. Although sacral plexus disorder caused by a rectal foreign body is extremely rare, physicians should be mindful to avoid misdiagnosis.

Download Full-text

929 Not Another Abscess - A Case of Streptococcal Myositis Misdiagnosed as a Right Axillary Abscess

British Journal of Surgery ◽

10.1093/bjs/znab134.176 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

O Oyende ◽

J Jackman

Keyword(s):

White Cell Count ◽

General Surgeon ◽

High Dose ◽

General Anaesthetic ◽

Microbiological Analysis ◽

Reactive Protein ◽

Affected Tissue ◽

Life Threatening ◽

History Of ◽

High Degree

Abstract Introduction Streptococcal myositis is a rare form of infectious myositis caused by Lansfield A beta-haemolytic streptococci. It is characterised by rapidly spreading inflammation that can result in severe systemic toxicity and necrosis of the affected tissue if not diagnosed and aggressively treated. Presentation We report a case of a 42-year-old male who presented with a one-week history of worsening right axillary swelling that progressed to painful swelling of his arm. Inflammatory markers were significantly elevated with a white cell count of 17 ×109/L and C-reactive protein of 212 mg/L. On examination, a fluctuant axillary swelling was appreciated, and a decision was made for incision and drainage under general anaesthetic. Intraoperative aspiration of his arm revealed copious purulent fluid prompting intraoperative orthopaedic consult and exploration of the anterior compartment in which there was extensive involvement of the biceps muscle. The microbiological analysis revealed gram-positive cocci in chains, and microbiology advice sought for tailoring of antibiotic regimen. He has recovered well. Discussion Though uncommon, the emergency general surgeon should have a high degree of suspicion when evaluating soft tissue infections to avert potentially disastrous outcomes. Conclusion Early diagnosis, aggressive management with high-dose intravenous antibiotics, and surgical debridement are principles to treat this rare, life-threatening infection.

Download Full-text

History of Pain is Associated with Hospitalization and Severe Course of COVID-19 in Children with Sickle Cell Disease

Journal of Pain ◽

10.1016/j.jpain.2021.03.118 ◽

2021 ◽

Vol 22 (5) ◽

pp. 607-608

Author(s):

Lana Mucalo ◽

Amanda Brandow ◽

Mahua Dasgupta ◽

Sadie Mason ◽

Pippa Simpson ◽

...

Keyword(s):

Sickle Cell Disease ◽

Sickle Cell ◽

Cell Disease ◽

History Of ◽

History Of Pain

Download Full-text

Nutritional Assessment of the Handicapped Child

Pediatrics in Review ◽

10.1542/pir.11.4.109 ◽

1989 ◽

Vol 11 (4) ◽

pp. 109-115

Author(s):

William H. Dietz ◽

Linda Bandini

Keyword(s):

Vitamin D ◽

Food Intake ◽

Case History ◽

Nutritional Assessment ◽

Pathologic Fracture ◽

Handicapped Child ◽

Great Effort ◽

Spastic Quadriplegia ◽

History Of ◽

History Of Pain

CASE HISTORY G.R. is a 7-year-old boy with spastic quadriplegia evident since birth and a seizure disorder for which he currently is being treated with phenobarbitol and phenytoin (diphenylhydantoin). His medical history includes a pathologic fracture of his right femur. At the time of his fracture, a radiograph of his femur was described as "markedly osteoporotic." He is currently being treated with 1200 IU of vitamin D. His diet as presented is balanced with respect to nutrients. Although spillage is not substantial, eating requires great effort, and each meal lasts approximately 1 hour. He is fed breakfast and supper at home by his mother and lunch in school. There is no history of pain with food intake, no vomiting, and no diarrhea. He weighs 14 kg (far below the 5th percentile), and his length is 112 (at the 5th percentile). His weight for height is far less than the 5th percentile. His mother is 157.5 cm (5 ft 2 in) tall and his father is 167.5 cm (5 ft 6 in) tall. His midarm circumference is 154 mm (less than the 5th percentile), his triceps skinfold is 5 mm (5th percentile), and his midarm muscle circumference is 138 mm (less than the 5th percentile).

Download Full-text

Giant retroperitoneal lipoma: a case report

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032003000400010 ◽

2003 ◽

Vol 40 (4) ◽

pp. 251-255 ◽

Cited By ~ 13

Author(s):

Carlos Augusto Real Martinez ◽

Rogério Tadeu Palma ◽

Jaques Waisberg

Keyword(s):

Case Report ◽

Histological Study ◽

Abdominal Mass ◽

Benign Neoplasm ◽

Large Mass ◽

White Female ◽

Ascending Colon ◽

Abdominal Ultrasonography ◽

History Of ◽

History Of Pain

BACKGROUND: Retroperitoneal lipoma is an extremely rare neoplasm. AIMS: The authors report a case of giant retroperitoneal lipoma in a 32-year-old white female, with a history of pain and an abdominal mass over a 2-year period. Total abdominal ultrasonography and barium enema showed a large mass located in the retroperitoneal space behind the ascending colon. Laparotomy showed a large encapsulated tumor measuring 20 x 13 x 10 cm and weighing 3.400 g. The histological study revealed a benign neoplasm of fatty cells. CONCLUSION: The patient remains well 17 years after surgery, without recurrentce of the disease.

Download Full-text