Adrenal Hemorrhage in Neonates: Unusual Presentation.

Adrenal hemorrhage (AH) is a relatively uncommon condition in newborns. It may be asymptomatic or may present with flank abdominal mass, anemia, jaundice, or rarely as scrotal bruising or hematoma. We report two cases of AH in neonates; the first presented with scrotal hematoma and the second with adrenal mass associated with hypertension and oliguria, primarily secondary to coincidental renal vein thrombosis. Diagnosis was confirmed by abdominal ultrasound. Patients were managed conservatively with clinical observation and by following hemoglobin and bilirubin levels closely. Both infants were discharged without surgical intervention after several days in the hospital. Clinicians should consider AH when a newborn presents with scrotal bruising or hematoma, unexplained anemia, unexplained jaundice, or flank abdominal mass. Timely ultrasonographic evaluation of both adrenal glands and testes in neonates with scrotal hematoma may spare infants from unnecessary surgical intervention because scrotal hematoma often raises the suspicion of testicular torsion.

Rational approach to diagnosis and management of blunt scrotal trauma.

OBJECTIVES: To provide a rational approach to the diagnosis and management of blunt scrotal trauma to aid clinicians in the selection of patients for surgical exploration. METHODS: We performed a retrospective evaluation of the medical records of 44 patients from two metropolitan tertiary referral hospitals. A total of 29 patients were recruited from July 1, 1993 to June 30, 2003 at one institution and an additional 15 patients from February 1, 1991 to January 31, 1999 at the second. Scrotal ultrasound scans were retrieved and reviewed by a uroradiologist unaware of the treatment regimen and outcome. RESULTS: The presence of both testicular swelling and tenderness suggested more significant testicular injury; however, testicular rupture was present in the absence of tenderness. Three patients with operatively confirmed testicular rupture had only swelling on clinical examination. Five patients with intratesticular hematoma were successfully treated conservatively with interval ultrasound scans recommended to assess for resolution. All patients with operatively confirmed testicular rupture had a combination of the following ultrasound features: the presence of hematocele, disruption of the tunica albuginea, and/or extrusion of the seminiferous tubules. CONCLUSIONS: Patients presenting after blunt scrotal trauma with clinical hematocele should progress directly to exploration. The remainder should undergo scrotal ultrasonography. Those with large hematoceles or suspected rupture on ultrasonography should also proceed to exploration. Those without hematocele, a clearly distinct tunica albuginea, and a lack of fracture planes within the testes are a subgroup that can be successfully treated conservatively.

Hematocele crónico calcificado. A proposito de un caso / Chronic calcified hematocele. Case report

Objetivo: Los hematoceles crónicos son una causa infrecuente de masa escrotal. Se asocian en la mayoría de los casos a traumatismos, cirugía previa, diabetes, neoplasias, torsión testícular o enfermedad arterioesclerótica. Presentamos el caso de un paciente de edad avanzada, diabético, que consulta en urgencias por presentar desde hace tres meses un cuadro de aumento de tamaño del hemiescroto derecho y supuración, así como fiebre y dolor. Método: Se le realiza ecografía y una tomografía (TC) abdomino-pélvica con extensión inguino-escrotal describiéndose los hallazgos encontrados en las pruebas de imagen y que nos pueden ayudar a caracterizar esta entidad clínica. Resultados/Conclusiones: El mecanismo de producción es el resultado de traumas menores sobre vasos dilatados. Suelen ir acompañando a procesos agudos como epididimitis y torsión testicular. Se presentan ecográficamente como masas heterogéneas con septos, tabiques y loculaciones en su interior. Muchos de ellos se resuelven con tratamiento conservador (AU)

Objective: Chronic hematoceles are rare scrotal masses. Most of them include trauma, torsion, tumor, and surgery as possible causes. We describe the case of an old diabetic patient, who is attended for presenting a marked increase in size of the right hemiescrotum and pain. Methods: We described computed tomography and sonographic findings. Results/Conclusions: Frequently, a varicocele is an associated finding. Presumibly, minor trauma results in rupture of dilated vessels. In sonographic exploration, they have a more complex heterogeneous appearance with echogenic debris and septations. Most hematoceles spontaneously resolve with conservative therapy (AU)

Quiste hemático de la orbita / The hematic cyst of the orbit

El quiste hemático es relativamente infrecuente. Su origen no es claro, pero ha sido descrito en asociación con trauma directo de órbita, hemorragia espontánea, discrasia sanguínea, linfangioma y hemorragioma cavernoso. Puede presentarse en cualquier grupo etáreo. Se reporta un caso de quiste hemático de órbita izquierda, sin antecedente traumático que clínicamente se diagnosticó como mucocele frontal izquierdo, describiéndose su tratamiento quirúrgico y el material histopatológico que concluye al diagnóstico definitivo