scholarly journals Relato de caso: Luxação testicular por trauma

2021 ◽  
Vol 7 (4) ◽  
pp. 26-28
Author(s):  
Gustavo Simon Mendes Ruiz ◽  
Giovanni Vitor Garabini ◽  
Paulo César Vieira dos Santos ◽  
Giovanni Montinni Sandoval
Keyword(s):  
Computed Tomography ◽  
Physical Examination ◽  
Lower Limb ◽  
Subcutaneous Tissue ◽  
Rare Event ◽  
Pelvic Trauma ◽  
Testicular Atrophy ◽  
Male Victim ◽  
Horse Riding ◽  
Testicular Dislocation

Resumo: Introdução: A luxação testicular após trauma perineal contuso é um evento raro, que ocorre principalmente em acidentes de motocicleta e traumas por montaria em cavalos. Devido à sua raridade e por estar geralmente associada com outras lesões graves, pode haver demora em seu diagnóstico e tratamento. O diagnóstico pode ser estabelecido no exame físico com a ausência de testículo no saco escrotal. Tomografia computadorizada (TC) e ultrassom com doppler também são ferramentas úteis no diagnóstico dessa condição. O tratamento pode ser realizado com redução manual ou cirurgia. Desenvolvimento: MJFS, masculino, vítima de acidente motociclístico com trauma contuso de pelve e membros inferiores. Durante a avaliação inicial foi constatada fratura de membro inferior esquerdo e disjunção da sínfise púbica. O paciente foi submetido a alinhamento do membro inferior e optou-se pelo tratamento conservador da disjunção púbica. Após um mês do acidente o paciente relata dor pélvica à esquerda. Ao exame físico foi constatada a ausência do testículo na bolsa escrotal esquerda com massa palpável dolorosa na região pélvica esquerda. Foi realizada então uma TC de pelve que mostrou o testículo esquerdo ectópico em tecido subcutâneo externo ao canal inguinal esquerdo. MJFS foi submetido à cirurgia para liberação e inserção do testículo na bolsa escrotal. O procedimento se deu sem intercorrências e o paciente recebeu alta em bom estado geral. Considerações finais: A luxação testicular é um evento facilmente detectado em exame físico. Pode provocar complicações como ruptura testicular, atrofia testicular, malignidade futura, infertilidade e disfunção endócrina, além de poder se associar com outras lesões como as de trato urinário. Dessa forma, é importante estar atento para sua ocorrência diante de um trauma pélvico.   Abstract: Introduction: Testicular dislocation after blunt perineal trauma is a rare event, which occurs mainly in motorcycle accidents and horse riding trauma. Due to its rarity and because it is usually associated with other serious injuries, there may be a delay in its diagnosis and treatment. The diagnosis can be established on physical examination with the absence of a testicle in the scrotum. Computed tomography and doppler ultrasound are also useful tools in the diagnosis of this condition. Treatment can be performed with manual reduction or surgery. Development: MJFS, male, victim of a motorcycle crash suffered a hip and lower limb contusion. During the initial evaluation, fracture of the left lower limb and a pubic disjunction were observed. The patient underwent lower limb alignment and conservative treatment of the public disjunction. After one month of the accident, the patient referred left pelvic pain. The physical examination revealed absence of the testicle in the left scrotum and a bulge in the left pelvic area, with tenderness. Then, a computed tomography (CT) scan was performed, which showed a left ectopic testicle in the subcutaneous tissue external to the left inguinal canal. MJFS underwent surgery to release and insert the testis into the scrotum. The procedure was uneventful and the patient was discharged without major complaints. Final considerations: Testicular dislocation is an easily detected event on physical examination. It can cause complications such as testicular rupture, testicular atrophy, future malignancy, infertility and endocrine dysfunction, in addition to being associated with other injuries such as urinary tract injuries. Thus, it is important to be aware of its occurrence in the face of a pelvic trauma.

Sonography of subcutaneous tissue cannot determine causes of lower limb edema

VASA ◽  
2015 ◽  
Vol 44 (2) ◽  
pp. 122-128 ◽  
Author(s):  
Mandy Becker ◽  
Tom Schilling ◽  
Olga von Beckerath ◽  
Knut Kröger
Keyword(s):  
Clinical Diagnosis ◽  
Lower Limb ◽  
Subcutaneous Tissue ◽  
Hepatic Disease ◽  
Clinical Use ◽  
Single Image ◽  
Heart Insufficiency ◽  
Chronic Hepatic Disease ◽  
Limb Edema ◽  
Venous Disorders

Background: To clarify the clinical use of sonography for differentiation of edema we tried to answer the question whether a group of doctors can differentiate lymphedema from cardiac, hepatic or venous edema just by analysing sonographic images of the edema. Patients and methods: 38 (70 ± 12 years, 22 (58 %) females) patients with lower limb edema were recruited according the clinical diagnosis: 10 (26 %) lymphedema, 16 (42 %) heart insufficiency, 6 (16 %) venous disorders, 6 (16 %) chronic hepatic disease. Edema was depicted sonographically at the most affected leg in a standardised way at distal and proximal calf. 38 sets of images were anonymised and send to 5 experienced doctors. They were asked whether they can see criteria for lymphedema: 1. anechoic gaps, 2. horizontal gaps and 3. echoic rims. Results: Accepting an edema as lymphedema if only one doctor sees at least one of the three criteria for lymphatic edema on each single image all edema would be classified as lymphatic. Accepting lymphedema only if all doctors see at least one of the three criteria on the distal image of the same patient 80 % of the patients supposed to have lymphedema are classified as such, but also the majority of cardiac, venous and hepatic edema. Accepting lymphedema only if all doctors see all three criteria on the distal image of the same patients no edema would be classified as lymphatic. In addition we separated patients by Stemmers’ sign in those with positive and negative sign. The interpretation of the images was not different between both groups. Conclusions: Our analysis shows that it is not possible to differentiate lymphedema from other lower limb edema sonographically.

Computed tomography angiography and microsurgical flaps for traumatic wounds: What is the added value?

2021 ◽  
pp. 1-9
Author(s):  
Lucas Sousa Macedo ◽  
Renato Polese Rusig ◽  
Gustavo Bersani Silva ◽  
Alvaro Baik Cho ◽  
Teng Hsiang Wei ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Upper Limb ◽  
Computed Tomography Angiography ◽  
Lower Limb ◽  
High Energy ◽  
Lower Limbs ◽  
Added Value ◽  
Vascular Lesions ◽  
Limb Injuries ◽  
Significant Difference

BACKGROUND: Microsurgical flaps are widely used to treat complex traumatic wounds of upper and lower limbs. Few studies have evaluated whether the vascular changes in preoperative computed tomography angiography (CTA) influence the selection of recipient vessel and type of anastomosis and the microsurgical flaps outcomes including complications. OBJECTIVE: The aim of this study was to evaluate if preoperative CTA reduces the occurrence of major complications (revision of the anastomosis, partial or total flap failure, and amputation) of the flaps in upper and lower limb trauma, and to describe and analyze the vascular lesions of the group with CTA and its relationship with complications. METHODS: A retrospective cohort study was undertaken with all 121 consecutive patients submitted to microsurgical flaps for traumatic lower and upper limb, from 2014 to 2020. Patients were divided into two groups: patients with preoperative CTA (CTA+) and patients not submitted to CTA (CTA–). The presence of postoperative complications was assessed and, within CTA+, we also analyzed the number of patent arteries on CTA and described the arterial lesions. RESULTS: Of the 121 flaps evaluated (84 in the lower limb and 37 in the upper limb), 64 patients underwent preoperative CTA. In the CTA+ group, 56% of patients with free flaps for lower limb had complete occlusion of one artery. CTA+ patients had a higher rate of complications (p = 0.031), which may represent a selection bias as the most complex limb injuries and may have CTA indicated more frequently. The highest rate of complications was observed in chronic cases (p = 0.034). There was no statistically significant difference in complications in patients with preoperative vascular injury or the number of patent arteries. CONCLUSIONS: CTA should not be performed routinely, however, CTA may help in surgical planning, especially in complex cases of high-energy and chronic cases, since it provides information on the best recipient artery and the adequate level to perform the microanastomosis, outside the lesion area.

scholarly journals Accuracy of Contrast Extravasation on Computed Tomography for Diagnosing Severe Pelvic Hemorrhage in Pelvic Trauma Patients: A Meta-Analysis

Medicina ◽  
2021 ◽  
Vol 57 (1) ◽  
pp. 63
Author(s):  
Sung Nam Moon ◽  
Jung-Soo Pyo ◽  
Wu Seong Kang
Keyword(s):  
Computed Tomography ◽  
Meta Analysis ◽  
Characteristic Curve ◽  
Pelvic Trauma ◽  
Test Accuracy ◽  
Trauma Patients ◽  
Positive Finding ◽  
Summary Receiver Operating Characteristic ◽  
Contrast Extravasation ◽  
Pelvic Hemorrhage

Background and objective: The early detection of underlying hemorrhage of pelvic trauma has been a critical issue. The aim of this study was to systematically determine the diagnostic accuracy of computed tomography (CT) for detecting severe pelvic hemorrhage. Materials and Methods: Relevant articles were obtained by searching PubMed, EMBASE, and Cochrane databases through 28 November 2020. Diagnostic test accuracy results were reviewed to obtain the sensitivity, specificity, diagnostic odds ratio, and summary receiver operating characteristic curve of CT for the diagnosis in pelvic trauma patients. The positive finding on CT was defined as the contrast extravasation. As the reference standard, severe pelvic hemorrhage was defined as an identification of bleeding at angiography or by direct inspection using laparotomy that required hemostasis by angioembolization or surgery. A subgroup analysis was performed according to the CT modality that is divided by the number of detector rows. Result: Thirteen eligible studies (29 subsets) were included in the present meta-analysis. Pooled sensitivity of CT was 0.786 [95% confidence interval (CI), 0.574–0.909], and pooled specificity was 0.944 (95% CI, 0.900–0.970). Pooled sensitivity of the 1–4 detector row group and 16–64 detector row group was 0.487 (95% CI, 0.215–0.767) and 0.915 (95% CI, 0.848–0.953), respectively. Pooled specificity of the 1–4 and 16–64 detector row groups was 0.956 (95% CI, 0.876–0.985) and 0.906 (95% CI, 0.828–0.951), respectively. Conclusion: Multi-detector CT with 16 or more detector rows has acceptable high sensitivity and specificity. Extravasation on CT indicates severe hemorrhage in patients with pelvic trauma.

scholarly journals Successful treatment of pyopneumothorax secondary to Streptococcus constellatus infection with linezolid: a case report and review of the literature

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Zhaorui Zhang ◽  
Binbin Xiao ◽  
Zhixin Liang
Keyword(s):  
Computed Tomography ◽  
Rare Event ◽  
Good Choice ◽  
Penicillin G ◽  
Computed Tomography Scan ◽  
Streptococcus Constellatus ◽  
First Case ◽  
Drug Sensitivity Test ◽  
Lung Condition ◽  
Tomography Scan

Abstract Background Pyopneumothorax secondary to Streptococcus constellatus infection is a clinically rare event, and few cases have been reported. Case presentation We report the case of a 55-year-old Han Chinese man with underlying diabetes who presented with fever of 17 days duration. A pulmonary computed tomography scan revealed right-sided massive pyopneumothorax. A culture of the pleural effusion and blood grew S. constellatus. A drug sensitivity test showed that the isolate was sensitive to linezolid, penicillin G, cefotaxime, vancomycin, and cefuroxime. Our patient was treated with linezolid for a total of 6 weeks. Subsequently, his chest computed tomography scan showed improved lung condition. Conclusion To the best of our knowledge, this is the first case of pyopneumothorax secondary to S. constellatus to be treated with linezolid. Pyopneumothorax may be caused by streptococcal infection, and linezolid is another good choice for treatment.

Cerebral mycetoma with cranial osteomyelitis

2008 ◽  
Vol 1 (6) ◽  
pp. 493-495 ◽  
Author(s):  
Vamseemohan Beeram ◽  
Sundaram Challa ◽  
Prasad Vannemreddy
Keyword(s):  
Computed Tomography ◽  
Cerebral Cortex ◽  
Parietal Cortex ◽  
Subcutaneous Tissue ◽  
Young Male ◽  
Ct Scanning ◽  
Parietal Bone ◽  
Total Excision ◽  
Farm Laborer ◽  
Left Parietal Cortex

✓ Craniocerebral maduromycetoma is extremely rare. The authors describe a case of maduromycetoma involving the left parietal cortex, bone, and subcutaneous tissue in a young male farm laborer who presented with left parietal scalp swelling that had progressed into a relentlessly discharging sinus. Computed tomography (CT) scanning of his brain revealed osteomyelitis of the parietal bone with an underlying homogeneously enhancing tumor. Intraoperatively, the mass was revealed to be a black lesion involving the bone, dura mater, and underlying cerebral cortex. It was friable and separated from the surrounding brain by a thick gliotic scar. Gross-total excision was performed, and the patient was placed on a 6-week regimen of itraconazole. To the authors' knowledge, this is the first instance of cerebral mycetoma with CT findings reported in the literature.

Multiphase vascular lower limb computed tomography: Assessment of patients doses and radiogenic risk

2021 ◽  
pp. 109675
Author(s):  
Rasha Jaafar ◽  
Abdelmoneim Sulieman ◽  
Nissren Tamam ◽  
Hiba Omer ◽  
Abdelrahman Elnour ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Lower Limb

Estimation of Hemi-Abdominal-Based Free Flap Weight Using Two Computed Tomography-Derived Measurements

2021 ◽  
Author(s):  
Nicolas Greige ◽  
Bryce Liu ◽  
David Nash ◽  
Katie E. Weichman ◽  
Joseph A. Ricci
Keyword(s):  
Computed Tomography ◽  
Breast Reconstruction ◽  
Free Flap ◽  
Subcutaneous Tissue ◽  
Free Tissue Transfer ◽  
Absolute Error ◽  
Estimation Methods ◽  
Weight Estimation ◽  
Estimation Model ◽  
Split Sample

Abstract Background Accurate flap weight estimation is crucial for preoperative planning in microsurgical breast reconstruction; however, current flap weight estimation methods are time consuming. It was our objective to develop a parsimonious and accurate formula for the estimation of abdominal-based free flap weight. Methods Patients who underwent hemi-abdominal-based free tissue transfer for breast reconstruction at a single institution were retrospectively reviewed. Subcutaneous tissue thicknesses were measured on axial computed tomography angiograms at several predetermined points. Multivariable linear regression was used to generate the parsimonious flap weight estimation model. Split-sample validation was used to for internal validation. Results A total of 132 patients (196 flaps) were analyzed, with a mean body mass index of 31.2 ± 4.0 kg/m2 (range: 22.6–40.7). The mean intraoperative flap weight was 990 ± 344 g (range: 368–2,808). The full predictive model (R 2 = 0.68) estimated flap weight using the Eq. 91.3x + 36.4y + 6.2z – 1030.0, where x is subcutaneous tissue thickness (cm) 5 cm lateral to midline at the level of the anterior superior iliac spine (ASIS), y is distance (cm) between the skin overlying each ASIS, and z is patient weight (kg). Two-thirds split-sample validation was performed using 131 flaps to build a model and the remaining 65 flaps for validation. Upon validation, we observed a median percent error of 10.2% (interquartile range [IQR]: 4.5–18.5) and a median absolute error of 108.6 g (IQR: 45.9–170.7). Conclusion We developed and internally validated a simple and accurate formula for the preoperative estimation of hemi-abdominal-based free flap weight for breast reconstruction.

scholarly journals Testicular dislocation: the importance of scrotal examination in a trauma patient

2012 ◽  
Vol 94 (2) ◽  
pp. e109-e110 ◽  
Author(s):  
A Naseer ◽  
D King ◽  
H Lee ◽  
J Vale
Keyword(s):  
Trauma Patient ◽  
Surgical Management ◽  
Rare Event ◽  
Perineal Trauma ◽  
Diagnosis And Treatment ◽  
Careful Examination ◽  
Timely Diagnosis ◽  
Appropriate Treatment ◽  
Testicular Dislocation

Testicular dislocation after blunt perineal trauma is a rare event and a diagnosis that can be easily overlooked. Careful examination can help facilitate early and appropriate treatment. Timely diagnosis and surgical management are of paramount importance to preserve normal spermatogenic function in the dislocated testicle. We describe a case of testicular dislocation and discuss some of the issues surrounding diagnosis and treatment.

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