Left Spermatic Vein Thrombosis - An Uncommon Diagnosis: A Case Report.

Introduction: Spermatic vein thrombosis is a rare entity with poor clinical distinctive signs for the differential diagnosis, which raises numerous controversies about the appropriate management. Case report: A 55 years old man presents at the emergency room for left scrotal pain and swelling evolving for two weeks. The patient denied any recent local traumatic event. Physical examination revealed an approximately 15 to 20 cm length mass from the posterior scrotum to the external inguinal orifice. The other genitals had a healthy appearance at the moment of the examination. An incarcerated hernia couldn't be excluded. The Doppler ultrasound evaluation of the scrotum con firmed the suspicion of left testicular vein thrombosis with complete cessation of blood flow. Both testicles appeared to have regular blood flow. CT scan established that the thrombus extended up to the left external inguinal orifice. Surgical treatment was preferred to address an eventually incarcerated hernia. The left testicular vein was excised from the external orifice. Postoperative management consisted of apixaban for 30 days, and the cardiology department thus conducted the treatment. Conclusions: Doppler ultrasound evaluation of the scrotum represents the gold standard diagnostic test for spermatic vein thrombosis. There are still controversies about the management approach of this pathology, conservative or surgical.

Can we renounce performing the intravenous urography in the preoperative evaluation for ESWL treatment?

OBJECTIVE: Our aim was to perform a comparative study between IVP (Intra Venous Pyelography) and Doppler US (Ultras Sound) in assessing the normal renal function. The US assessment of the normal renal function consisted in the evaluation of ureteral flux. MATERIALS AND METHODS: The group of patients consisted in 79 patients with small size urinary stones (5-12 mm). Among them, 58 patients had pelvic stones and 21 patients had ureteral stones. The ultrasound system used in our study was a B&K Medical Panther 2002 equipped with a 3.5 MHz transducer. RESULTS: The sensibility in detecting ureteral flux in patients with pelvic stones and normal IVP was 100%. The sensibility in detecting uretheral flux in ureteral stones with IVP aspect of hydronephrosis was 65%. CONCLUSIONS: In cases of normal aspect of IVP the presence of uretheral flux assessed by ultrasound could substitute the IVP in the preoperative evaluation for ESWL treatment. In cases of hydronephrotic aspect of IVP, the concordance between results based on IVP and those based on Doppler US in good enough for proposing the Doppler US evaluation of renal function in obstructive stones as a new diagnostic imaging modality. Doppler US could be the method of choice for renal function pre ESWL evaluation mainly for patients with known intolerance to contrast media.

US and MRI in renal obstruction evaluation.

OBJECTIVE: To explore the renal obstruction using MRI (Magnetic Resonance Imaging) for anatomical evaluation and Doppler US (Ultra Sound) for functional evaluation. MATERIALS AND METHODS: Thirty-two patients with renal obstruction were investigated. The presence of renal obstruction was subsequently established by excretory urography or surgery. US studies were performed using a B&K Medical ultrasound system Panther 2002 equipped with 3 Mhz transducer. MR urography was done with a magnetic resonance imaging system 0.28T, Tomikon R28-Bruker, Germany. RESULTS: All 30 patients presented increased renal vascular resistance as determined by US evaluation (Resistive Index = 0.74 +/- 0.02). The MR urography proved dilated urinary collecting system in only 20 patients of the group. CONCLUSIONS: Doppler US has a very good sensitivity in detecting the renal obstruction before the dilatation of the collecting system be installed. Used together these methods (US and MR urography) are important for proving anatomical as well as functional changes in renal obstruction. Both methods could be useful mainly in patients with known intolerance to contrast media.