RESUMEN
Polyorchidism is a rare congenital anomaly usually found on the left side and frequently associated with inguinal hernia, testicular torsion, and cryptorchidism. An increased risk of testicular malignancy has been reported in cases of Polyorchidism.1 It may be detected as a scrotal mass in children or may go undetected till adult life and found incidentally. Different classifications of supernumerary testis exist depending on the location of the extra testis and its relationship to the native testis and the vas deferens. The most commonly occurring presentation is one of an extra testis or triorchidism on the left side. We report here a case of Triorchidism in a young male patient who was clinically suspected to have an epididymal cyst.Polyorchidism, or supernumerary testicle is the presence of more than two testes, most frequently presenting as triorchidism1 It is an extremely rare congenital anomaly of the urogenital system and there are only about a hundred documented cases in literature. We describe here a rare case of Triorchidism in a 21-year-old male patient who presented with long standing left sided painless scrotal swelling, clinically suspected to be an epididymal cyst and evaluated using high resolution Ultrasonography including Colour Doppler and Magnetic Resonance Imaging (MRI). Ultrasound demonstrated the supernumerary testis to be located posterosuperior to the native left testis with each having their own epididymal and vas deferens connection. MRI confirmed the presence of supernumerary testicle with an abnormal signal intensity on T2W images appearing homogenously hypointense in contrast to the hyperintense signal on T2W images of the two normal testicles leading to the suspicion of the occurrence of seminomatous transformation of the testicle. The finding of necrotic enlarged iliac, inguinal, pre and para aortic lymph nodes both on ultrasonographic and MRI evaluation further supported the suspicion of a seminomatous transformation.
RESUMEN
Sphenoid sinus of all sinuses is generally the most inaccessible sinus to the surgeons. The trans-sphenoid route is considered to be the standard approach for surgery of pituitary adenomas. Knowing the details of the anatomy of sphenoid sinus and the extent of pneumatization can guide the surgeon through difficult corners of the approach. We wanted to evaluate the incidence of the different anatomical variations of sphenoid sinus as detected by HRCT scan and their impact on related neurovascular structures for the safe removal of inter sphenoid and pituitary lesions.METHODSThis prospective study was conducted in Sree Gokulam Medical College & Research Foundation, Trivandrum. Study population included 150 cases who were referred for HRCT of the paranasal sinuses to the Department of Radiodiagnosis, over a period of 12 months (from November 2018 to October 2019). After obtaining a written informed consent and history, all the patients underwent HRCT axial section of PNS. Once the axial sections were obtained through the paranasal sinuses, these images were reconstructed into coronal sections by multiplanar reconstruction (MPR) technique without exposing the patient.RESULTSOnodi cells were found predominantly in female patients with male:female ratio 2:7. Optic nerve protrusion and dehiscence had male predominance. Rest of the variations had no significant gender difference and few variations were seen equally distributed among both males and females. The most common variation observed in our study was pterygoid process pneumatization. Of the total 150 patients, pterygoid process pneumatization was identified in 76 patients including bilateral in 54 patients. Next common variation observed was vidian nerve protrusion, identified in 62 patients along with dehiscence of wall in 38 patients. Maxillary nerve protrusion was present in 42 patients and its dehiscence of wall in 10 patients. Optic nerve protrusion was identified in 41 patients and dehiscence of wall was noted in only 6 patients.CONCLUSIONSSphenoid sinuses are the most inaccessible paranasal sinuses and are surrounded by significant anatomical structures such as the orbit and its contents, cavernous sinus, internal carotid artery (ICA) and the anterior cranial fossa. HRCT of sphenoid sinus for the demonstration of the anatomical variations and its relation to the vital adjacent crucial anatomical structures helps in reducing the complications during trans-sphenoidal surgeries and functional endoscopic sinus surgery. Our study of HRCT findings delineates most of the anatomical variations in sphenoid sinus and thus helps the surgeons in appropriate surgical planning and helps them to reduce the intraoperative complications.