Intermittent azoospermia associated with epididymal sarcoidosis.

OBJECTIVE: To report an unusual case of intermittent azoospermia associated with epididymal sarcoidosis. DESIGN: Retrospective case analysis. SETTING: Wilford Hall Medical Center. PATIENT(S): A 36-year-old male with secondary infertility and epididymal sarcoidosis. INTERVENTION(S): None. MAIN OUTCOME MEASURES(S): An analysis of sperm count in relation to steroid courses. RESULTS(S): Epididymalgia, and to a lesser extent, sperm counts were noted to fluctuate temporally around steroid courses given for pulmonary flares of sarcoidosis. Epididymal sarcoidosis can be associated with intermittent azoospermia. Presumably, epididymal granulomas undergo exacerbations and remissions and cause intermittent ductal obstruction. CONCLUSIONS(S): Because of the unpredictable effect of sarcoidosis on the male genital tract, all patients interested in paternity should obtain a semen analysis at the time of disease diagnosis. If oligospermia is noted or if there is clinical evidence of epididymal involvement, the patient should be offered sperm banking for possible future assisted reproductive techniques.

Experimental pyelonephritis in piglets: diagnosis with MR imaging.

PURPOSE: To compare findings at magnetic resonance (MR) imaging with those at histopathologic examination in the detection of experimentally induced pyelonephritis in piglets. MATERIALS AND METHODS: MR imaging was performed in 23 piglets with and nine piglets without experimentally induced pyelonephritis. Escherichia coli were injected into the bladder of the 23 piglets with surgically created vesicoureteral reflux. Imaging was performed with unenhanced and contrast material-enhanced T1-weighted and fast multiplanar inversion-recovery (IR) and fast spinecho T2-weighted sequences. MR images and pathologic findings were reviewed independently by two pediatric radiologists and a pathologist, respectively, in a blinded fashion. RESULTS: Sixty-four kidneys and 192 renal zones were evaluated. Coronal gadolinium-enhanced fast multiplanar IR imaging was the only sequence that was sensitive and specific for the diagnosis of pyelonephritis. For the two reviewers, respectively, sensitivity was 85% (n = 75) and 92% (n = 81) of 88 histopathologically positive zones and specificity was 95% (n = 99) and 94% (n = 98) of 104 pathologically negative zones. Findings at gadolinium-enhanced fast multiplanar IR imaging were not statistically different from findings at histopathologic examination in the detection of pyelonephritis. Interobserver reproducibility for the contrast-enhanced fast multiplanar IR sequence was excellent (kappa statistic = 0.82 and 0.90, respectively, for interpretation of a renal zone and of a kidney). CONCLUSION: Contrast-enhanced fast multiplanar IR imaging is a sensitive and specific test for detection of experimental pyelonephritis in this piglet model.

Renal cell carcinoma arising from the free wall of a renal cyst.

We report an unusual case of a 1 cm papillary renal cell carcinoma arising from the outer surface of the free wall of a radiographically simple renal cyst. Most malignancies arising from the wall of a renal cyst are present along the inner surface, usually adjacent to underlying renal parenchyma. While this is a rare occurrence, it does reinforce the need to explore even small solid renal masses.