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Hungarian Radiology

DECEMBER 10, 2005

[Ultrasound of the acute pediatric scrotum]

COLEY D. Brian

[Proper evaluation of the acute scrotum, like any condition, starts with a history and physical examination by an experienced clinician. Often this is all that is needed to arrive at an accurate diagnosis, which then allows prompt and appropriate treatment. However, the true nature of the underlying disease producing scrotal pain is not always clear, and the consequences of error (testicular loss) are undesirable. Ultrasound is the single most useful imaging tool for imaging the scrotum. While nuclear medicine studies can help assess blood flow, the combination of anatomic detail provided by modern ultrasound equipment and the ability to assess blood flow and perfusion with color Doppler makes ultrasound invaluable. Properly performed and interpreted, ultrasound provides very high sensitivity and specificity for acute scrotal conditions. Understanding of the conditions that produce acute scrotal pain in children will improve one’s diagnostic abilities. The most important diagnosis to consider is testicular torsion, since untreated this will result in testicular death. While testicular torsion can occur at any age, it is most common in the perinatal and peripubertal age groups. Torsion of a testicular appendage is a frequent cause of scrotal pain in prepubertal males. The sonographic findings can mimic epididymitis, but diligent and focused sonographic examination can make the diagnosis. Epididymitis typically affects postpubertal males, but can be seen in younger patients with functional or anatomic urinary tract anomalies. Sonographic evaluation of the post-traumatic painful scrotum can help to differentiate injuries that can be managed conservatively and those that require surgery. Less common causes of scrotal pain include hernias and hydroceles, vasculitis, and idiopathic edema. Understanding the characteristic sonographic features of these conditions allows the examining physician to make more accurate and confident diagnoses. It is hoped that this review article will help to promote this understanding.]

Lege Artis Medicinae

JULY 20, 2006

[WEGENER’S GRANULOMATOSIS PRESENTING AS MASTOIDITIS: A DIAGNOSTIC CHALLENGE]

NAGY Pál, Z.SZABÓ László, DOMJÁN Gyula, GADÓ Klára, BALOGH Károly

[INTRODUCTION - Wegener's granulomatosis has an uncertain pathomechanism, but is probably autoimmune in origin. In typical cases the mucosa of the nose, paranasal sinuses and of the lower respiratory tract, as well as the lungs and the kidneys are affected. Patients present with sinusitis, recurrent pneumonia or renal disease associated with microhaematuria, pyuria or azotaemia. Fever, polyarthralgia or polyarthritis may also occur. The underlying pathologic changes are necrotizing vasculitis, granulomas and parenchymal necrosis. The diagnosis is based on a combination of the clinical picture, microscopic findings and immunofluorescent demonstration of cANCA. CASE REPORT - A 27-year-old woman presented with symptoms of unilateral mastoiditis. In the following 7 months she underwent 7 operations in 4 hospitals for a locally progressive, destructive process of uncertain etiology showing a septic course. The clinical picture was not specific, the cANCA test was not definitive, and the histologic findings were initially interpreted as nonspecific inflammation. Repeated biopsies, multiple reviews of the microscopic specimens, consultations, differential diagnostic considerations, and, finally, the success of the treatment with corticosteroids and cyclophosphamide led to the diagnosis of Wegener’s granulomatosis. Currently the patient has been in remission for 32 months. CONCLUSION - The definitive diagnosis of Wegener’s granulomatosis, particularly of its localized or limited form, may be problematic despite well-defined diagnostic criteria. Setting up the correct diagnosis may take months or years. In case of unusual respiratory or otological symptoms, and in view of ineffective medical or surgical treatment, Wegener’s granulomatosis has to be considered. An atypical clinical picture, inconclusive histologic, radiologic and laboratory findings warrant the need for close collaboration of various specialists. This is particularly important since state-of-the-art therapy of Wegener’s granulomatosis promises a favourable prognosis.]

Lege Artis Medicinae

SEPTEMBER 10, 2001

[Wegener’s granulomatosis: diagnostic questions]

CSISZÉR Eszter, SOLTÉSZ Ibolya, FÜZESI Katalin

[INTRODUCTION - Wegener’s granulomatosis is a disease of unknown origin classified as an immune vasculitis. The main pathologic feature is necrotising granulomatous small vessel vasculitis. Clinically the upper and/or lower airways are affected most often as well as the kidneys in the generalised form. The highly specific antineutrophil cytoplasmic antibodies have diagnostic significance beside the pathology and clinical symptoms. PATIENTS AND METHODS - We have studied the clinical and diagnostic characteristics of 15 cases diagnosed in our centre from the last 25 years. All patients had pulmonary manifestation. We analysed the organ involvement, clinical signs indicating the diagnosis, chest radiography, chances for biopsies of diagnostic significance and the difficulties of differential diagnostics. RESULTS - The diagnosis was made based on histological samples from the upper airways in three cases and from the lower airways in six cases (in four cases the bronchoscopic biopsies were diagnostic, in two patients thoracotomy was necessary). In six cases, clinical signs and typical organ manifestations were the basis of the diagnosis. CONCLUSION - This very rarely occurring disease which is difficult to recognise requires pulmonological examination due to the involvement of lungs. If this diagnosis comes to mind - based on findings of bilateral, multiplex, round pulmonal shadows with cavitation - the pulmonologist should search for other organ manifestations and involve respective specialists. Ideally, diagnosis is established by histopathology or by positive cytoplasmic antineutrophil cytoplasmic antibodies.]