DOCSLIB.ORG

Atypical Manifestations of Ruptured Abdominal Aortic Aneurysms

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Atypical Manifestations of Ruptured Abdominal Aortic Aneurysms Postgrad Med J: first published as 10.1136/pgmj.69.807.6 on 1 January 1993. Downloaded from Postgrad Med J (1993) 69, 6- 11 © The Fellowship of Postgraduate Medicine, 1993 Review Article Atypical manifestations ofruptured abdominal aortic aneurysms A. Banerjee Accident and Emergency Department, East Birmingham Hospital, Bordesley Green East, Birmingham B95ST, UK Introduction The rupture of an abdominal aortic aneurysm is a The majority of published series of ruptured catastrophic event with a uniformly fatal outcome abdominal aortic aneurysms deal with the outcome if untreated. The triad of abdominal and/or back of those submitted to surgery. Untreated cases, pain, a pulsatile abdominal mass, and hypotension, misdiagnoses and delayed diagnoses are generally is said to be diagnostic. However, this triad may not not discussed. Hence the precise extent of these be present in its entirety, or when present may not problems is unclear. be recognized, as one of the components However, data from various sources suggest that predominates. Clinical diagnosis is thus 'not infre- the diagnosis of ruptured abdominal aortic quently missed in the emergency rooms ofeven the aneurysms is difficult and often missed. In a study most prestigious medical centers." of 9.894 autopsies in two Glasgow hospitals,6 41 To add to this, difficulties in diagnosis may arise patients were noted to have died in hospital with owing either to an impalpable aneurysm or to unoperated ruptured abdominal aortic aneurysms. copyright. atypical presentations.2'3 The clinical diagnosis is The diagnostic triad was present in nine. The often difficult and not infrequently missed. Conse- correct diagnosis had been made in 24. In a series of quently, appropriate treatment in the form of 100 ruptured aneurysms admitted to hospital,7 in expeditious laparotomy, rapid control of the prox- 58 cases surgery was delayed. In 42 instances this imal aorta and graft replacement ofthe aneurysmal was due to an incorrect diagnosis. Emergency aorta is not achieved leading to possibly avoidable operation was performed for an incorrect diagnosis mortality. in five cases. The purpose of this report is to discuss less The implications of this are thatjunior staff may http://pmj.bmj.com/ common presentations of ruptured aneurysms of not be prepared to deal with the ruptured aneurysm the abdominal aorta, concentrating on the clinical when encountered and cross-matched blood may aspects. not be available. Of 44 admissions to a hospital with ruptured aneurysms of the abdominal aorta,8 in 15 patients Extent ofthe problem the diagnosis was missed altogether. In another study of 47 patients with ruptured abdominal on September 28, 2021 by guest. Protected The incidence of abdominal aortic aneurysms aortic aneurysm who died in hospital over a 4 year appears to be rising, independent of any increased period, the diagnostic triad was noted in only 19 detection from improved diagnostic techniques.4 In patients.9 Twenty-four patients underwent surgery, the absence of any effective community screening only 16 having had the correct preoperative diag- programme and also because symptomatic aneur- nosis. ysms are treated surgically at an early stage, In a series of 119 patients with ruptured ruptured previously undiagnosed aneurysms con- abdominal aortic aneurysms who reached a hos- tinue to arrive in hospital. Methods to detect pital alive,'0 20 died in the Accident and Emergency aneurysms based on community screening by Department (only five being diagnosed correctly), clinical examination are, in any case, likely to be and 24 died on the ward without surgery (nine inaccurate.5 This implies that rupture is often the being undiagnosed). first clue to the presence of an aneurysm. Of 120 patients with ruptured abdominal aortic aneurysms in one health district," 12 died in hospital from undiagnosed rupture. Of 56 deaths Correspondence: A. Banerjee, F. R.C.S. outside hospital, 27 had been seen before death by a Accepted: 18 June 1992 doctor but the correct diagnosis was not suspected. Postgrad Med J: first published as 10.1136/pgmj.69.807.6 on 1 January 1993. Downloaded from RUPTURED ABDOMINAL AORTIC ANEURYSMS 7 In the above series, failure to consider the correct presentation of abdominal aortic aneurysmal rup- diagnosis and to recognize atypical presentations ture, in association with fistula formation with contributed directly to most of the deaths. It is either the inferior vena cava or the left renal unfortunately not possible to comment on the vein.'8-20 Haematuria in the presence of a symp- relative proportions. Inappropriate orthopaedic, tomatic aneurysm must be considered as being due urological, neurological and medical referrals to the aneurysm until proven otherwise. Systemic resulted in many instances. Commonly recorded circulatory effects ofthe fistula must be sought. The misdiagnoses are enumerated in Table I. haematuria has been attributed to venous conges- tion of the kidney and bladder, and characteris- tically clears promptly with resection of the Urological presentations aneurysm. Urological presentations are not infrequent. Ten per cent of a series of 400 patients with abdominal Neurological presentations aortic aneurysms (intact and ruptured) who under- went surgery for the aneurysm presented with The precise incidence of neurological complica- features suggesting genitourinary disease.12 tions associated with ruptured abdominal aortic Unilateral flank pain, either right- or left-sided, aneurysm is not known. However, they appear to with distal radiation to the genitalia, hip and thigh, be relatively uncommon. A ruptured abdominal is often a presenting feature ofaneurysmal rupture. aortic aneurysm can present as an acute unilateral This may be misdiagnosed as ureteric colic.'3 4 The painful neuropathy affecting the femoral and/or cause of this pain is believed to be irritation of the obturator nerves.2'125 A similar constellation of ureteric pain fibres in the sympathetic plexus by the symptoms and signs has been previously en- retroperitoneal haematoma. This appears to be a countered with patients on anticoagulant therapy relatively common diagnostic problem. In one and in haemophiliacs. The mechanism is that of series of 44 cases of aneurysmal rupture, five were pressure on these nerves by the extraperitoneal noted to have ureteric colic-like presentation.8 In haematoma present in each instance. copyright. another series of 105 patients, 18 presented with The presentation is with severe hip and thigh unilateral loin pain.'5 pain, paraesthesiae and sensory loss of femoral In many cases, the misdiagnosis of ureteric colic nerve distribution (anteromedial thigh), weakness leads to inappropriate intravenous urography, of hip flexion (iliopsoas) and of knee extension with deterioration during, or immediately after, the (quadriceps femoris) and loss of the knee jerk. In procedure (Figure 1). One must be wary ofthe first many reported instances, inappropriate neuro- episode of ureteric colic in the middle aged and logical and orthopaedic investigation has been elderly, and leaking abdominal aortic aneurysm associated with delayed diagnosis. The neuropathy http://pmj.bmj.com/ must be part of the differential diagnosis. In the is reversible with early definitive treatment of the haemodynamically stable patient, ultrasound aneurysm but, if this is delayed, residual assessment is recommended.'6 This can demon- neurological deficit with prominent quadriceps strate both aneurysmal leakage as well as urinary wasting ensues. Intractable sciatica owing to sciatic tract obstruction. Three cases of isolated severe nerve compression by haematoma has also been unilateral testicular pain have been reported as the described. The presentation has been with severe sole presentation of aneurysmal rupture."' The gluteal pain, restricted straight leg raising and postulated mechanism is haematoma causing pres- normal neurological examination.26 Clearly in the on September 28, 2021 by guest. Protected sure on visceral afferent pain fibres from the testes. situation with a normal lumbar spine X-ray and Massive haematuria has been described as a aortic calcification, one must be wary of ruptured abdominal aortic aneurysm. Other reported presentations include lateral Table I Common misdiagnoses in patients with popliteal nerve palsy with foot drop (attributed to ruptured abdominal aortic aneurysms occlusion of the artery to the sciatic nerve)27 and various root compression syndromes.28 Acute Ureteric colic paraplegia has also been reported as a presentation Prolapsed lumbar intervertebral disc of aneurysmal rupture,27'29 although this is more Sciatica likely to occur as a result ofaortic thrombosis or as Acute myocardial infarction a postoperative complication. Acute sympathetic Perforated peptic ulcer paralysis causing a unilateral warm dry foot can Acute pancreatitis Acute cholecystitis occur as a complication of aneurysmal rupture. Mesenteric vascular occlusion Haematoma causing damage to the sympathetic Acute diverticulitis ganglia has been implicated as the cause.30 The message is that acute painful neuropathies in Postgrad Med J: first published as 10.1136/pgmj.69.807.6 on 1 January 1993. Downloaded from 8 A. BANERJEE the lower limbs and acute nerve root compression inguinal canal.41- This may lead to inguinal syndromes in the middle aged or elderly can be herniorrhaphy as an emergency procedure, when a caused by aortic aneurysmal rupture, which must haemorrhagic hernial sac and/or retroperitoneal be considered
Load more

Recommended publications
  • Varicocele.Pdf
    Page 1 of 4 View this article online at: patient.info/health/varicocele-leaflet Varicocele A varicocele is like varicose veins of the small veins (blood vessels) next to one testicle (testis) or both testicles (testes). It usually causes no symptoms. It may cause discomfort in a small number of cases. Having a varicocele is thought to increase the chance of being infertile but most men with a varicocele are not infertile. Treatment is not usually needed, as most men do not have any symptoms or problems caused by the varicocele. If required, an operation can clear a varicocele. There is no agreement among experts as to whether treatment of a varicocele will cure infertility. If you are infertile and have a varicocele, it is best to discuss this with a specialist who will be up to date on current research and thinking in this area. What is a varicocele? A varicocele is a collection of enlarged (dilated) veins (blood vessels) in the scrotum. It occurs next to and above one testicle (testis) or both testes (testicles). The affected veins are those that travel in the spermatic cord. The spermatic cord is like a tube that goes from each testis up towards the lower tummy (abdomen). You can feel the spermatic cord above each testis in the upper part of the scrotum. The spermatic cord contains the tube that carries sperm from the testes to the penis (the vas deferens), blood vessels, lymphatic vessels and nerves. Normally, you cannot see or feel the veins in the spermatic cord that carry the blood from the testes.
    [Show full text]
  • Bilateral Varicoceles As an Indicator of Underlying Portal-Hypertension
    African Journal of Urology (2016) 22, 210–212 African Journal of Urology Official journal of the Pan African Urological Surgeon’s Association web page of the journal www.ees.elsevier.com/afju www.sciencedirect.com Andrology/Male Genital Disorders Case report ‘Opening a can of worms’: Bilateral varicoceles as an indicator of underlying portal-hypertension a,1,∗ a b c A. Adam , W.C. Mamitele , A. Moselane , F. Ismail a Department of Urology, University of Pretoria, Pretoria, South Africa b Department of Urology, 1 Military Hospital, Pretoria, South Africa c Department of Radiology, University of Pretoria, Pretoria, South Africa Received 22 December 2015; accepted 24 January 2016 Available online 1 August 2016 KEYWORDS Abstract Varicocele; The scrotal varicocele is a common finding encountered during clinical examination. A porto-systemic Portal hypertension; shunt presenting with an associated varicocele is exceptionally rarely reported. Herein, we report such a Portosystemic shunt case in an HIV positive man who presented with bilateral varicoceles. This is only the fifth case of such an association in the world literature. A literature review and the possible underlying pathophysiological mechanisms of this rare association are expanded further. © 2016 Pan African Urological Surgeons’ Association. Production and hosting by Elsevier B.V. All rights reserved. Introduction ∗ Corresponding author. A varicocele is defined as an abnormal tortuosity and dilatation of E-mail address: [email protected] (A. Adam). the testicular veins and pampiniform plexus. This may be present 1 Current affiliation: Consultant Urologist, Adult and Paediatric Urol- due to absent or incompetent valves, or increased hydrostatic pres- ogy, Head Consultant, Department of Urology, Helen Joseph Hospital, & sure [1].
    [Show full text]
  • A Rare Case of Right-Sided Varicocele in Right Renal Tumor in the Absence of Venous Thrombosis and IVC Compression
    Adhikari et al. Afr J Urol (2020) 26:63 https://doi.org/10.1186/s12301-020-00072-3 African Journal of Urology CASE REPORTS Open Access A rare case of right-sided varicocele in right renal tumor in the absence of venous thrombosis and IVC compression Priyabrata Adhikari, Siddalingeshwar I. Neeli* and Shyam Mohan Abstract Background: The presence of unilateral right-sided varicocele hints at a serious retroperitoneal disease such as renal cell neoplasm. Such tumors are usually associated with a thrombus in renal vein or spermatic vein. We report a rare presentation of right-sided renal tumor causing right-sided varicocele in the absence of thrombus in renal vein and spermatic vein but due to an anomalous vein draining from the tumor into the spermatic vein as demonstrated by computed tomography angiogram. Case presentation: A 54-yr-old hypertensive male presented with unilateral grade 3 right-sided varicocele and no other signs and symptoms. Ultrasound examination of his abdomen showed the presence of a mass lesion in the lower pole of right kidney. Computed tomography confrmed the presence of right renal mass, absence of throm- bus in right renal vein or inferior vena cava. The angiographic phase of CT scan showed an anomalous vein from the tumor draining into the pampiniform plexus causing varicocele. Conclusion: The presence of right-sided varicocele should raise a suspicion hidden serious pathological retroperito- neal condition, renal malignancy in particular, and should prompt the treating physician to carry out imaging studies of the retroperitoneum and careful study of the angiographic phase of the CT scan can ascertain the pathogenesis of the varicocele.
    [Show full text]
  • Causes of Death and Comorbidities in Hospitalized Patients with COVID-19
    www.nature.com/scientificreports OPEN Causes of death and comorbidities in hospitalized patients with COVID‑19 Sefer Elezkurtaj1*, Selina Greuel1, Jana Ihlow1, Edward Georg Michaelis1, Philip Bischof1,2, Catarina Alisa Kunze1, Bruno Valentin Sinn1, Manuela Gerhold1, Kathrin Hauptmann1, Barbara Ingold‑Heppner3, Florian Miller4, Hermann Herbst4, Victor Max Corman5,6, Hubert Martin7, Helena Radbruch7, Frank L. Heppner7,8,9 & David Horst1* Infection by the new corona virus strain SARS‑CoV‑2 and its related syndrome COVID‑19 has been associated with more than two million deaths worldwide. Patients of higher age and with preexisting chronic health conditions are at an increased risk of fatal disease outcome. However, detailed information on causes of death and the contribution of pre‑existing health conditions to death yet is missing, which can be reliably established by autopsy only. We performed full body autopsies on 26 patients that had died after SARS‑CoV‑2 infection and COVID‑19 at the Charité University Hospital Berlin, Germany, or at associated teaching hospitals. We systematically evaluated causes of death and pre‑existing health conditions. Additionally, clinical records and death certifcates were evaluated. We report fndings on causes of death and comorbidities of 26 decedents that had clinically presented with severe COVID‑19. We found that septic shock and multi organ failure was the most common immediate cause of death, often due to suppurative pulmonary infection. Respiratory failure due to difuse alveolar damage presented as immediate cause of death in fewer cases. Several comorbidities, such as hypertension, ischemic heart disease, and obesity were present in the vast majority of patients.
    [Show full text]
  • Charlotte Radiology Parent Bros
    Up to 40% of women in the United States suffer from fibroids. VASCULAR & CONDITIONS TREATMENTS Approximately INTERVENTIONAL 30% of men who Chemoembolization PROCEDURES are evaluated for infertility will Radioembolization Liver (primary and metastatic), have varicoceles. Microwave Ablation Renal & Lung Cancers Radiofrequency Ablation Cryoablation One in every 20 Americans over Compression Fractures Kyphoplasty/Vertebroplasty the agege of 50 has PAD, Deep Vein Thrombosis (DVT) DVT Thrombolysis Therapy a condition linked to an Pelvic Congestion Syndrome Pelvic Vein Embolization increasedcreased risrisk of heart attack Angioplasty and stroke. Peripheral Artery Disease Thrombectomy Stent Placement Stroke Stroke Intervention with clot removal Up to TWO MILLION Uterine Fibroids Uterine Fibroid Embolization Americans suffer from DVT, 1/3 resulting in approximately Varicoceles Varicocele Embolization of hysterectomies 300,000 DEATHS are due to fibroids.* annually from pulmonary embolism. Visit CharlotteRadiology.com for more information on procedures, technology, our subspecialized physicians and more. *Performed annually in the United States The softer side of surgery. COMPRESSION FRACTURES UTERINE FIBROIDS Osteoporotic patients can experience painful compression Uterine fibroids are the most common form of fractures when height loss and spine curvature put stress on the noncancerous uterine tumors, affecting 25 – 40% of backbone. During kyphoplasty and vertebroplasty, our physicians women. Fibroids can cause significant discomfort, inject special medical-grade bone cement into the fractured including pelvic pain, cramping, heavy menstrual vertebra to create an internal cast. This helps to alleviate pain, bleeding, bladder pressure and constipation. Fibroids optimize healing and restore mobility. are treatable with Uterine Fibroid Embolization (UFE), a minimally invasive procedure performed by an DEEP VEIN THROMBOSIS (DVT) interventional radiologist.
    [Show full text]
  • Scrotal Swelling in Adults, an Indication of Iga Vasculitis Jennifer Doran, MD1; Natalie Longino1; Lakshmipriya Karamsetty 2; Jeffrey Spence3; Noelle Northcutt4 1
    Scrotal Swelling in Adults, an Indication of IgA Vasculitis Jennifer Doran, MD1; Natalie Longino1; Lakshmipriya Karamsetty 2; Jeffrey Spence3; Noelle Northcutt4 1. University of Colorado Internal Medicine Residency Program; 2. University of Colorado School of Medicine ; 3. Denver Health Division of Hospital Medicine Case description Imaging Discussion Presentation: - Given degree of SSTI from IVDU, there was high concern A 46 year old homeless man with history of IV drug use for infectious etiology of scrotal findings despite having presented with 12 hours of scrotal swelling, redness and classic rash pain. - IgA vasculitis = Most common form of systemic vasculitis - 3 days of pruritic, non painful rash on thighs, buttocks, in children, 3-26.7 of 100,000 persons /yr, compared to and trunk 0.8-1.8 of 100,000 persons/yr in adults - Heroin use day of presentation, to right upper thigh - Classic features: non-thrombocytopenic palpable - No fever, abdominal pain, hematuria, or dysuria purpura, abdominal pain, hematuria, and arthritis - Other organ involvement: CNS, lungs, scrotum, eyes Physical Exam - Scrotal manifestations (2-32% prevalence): epididymitis, - Vitals: 36.4 C, HR 79, BP 126/92, RR 16, O2 94% on RA orchitis, and spermatic cord involvement. Figure 1: Posterior right leg, evidence of palpable, Figure 2: Diffuse purpura of entire - Diffuse purpuric, non-blanching rash of lower - Treatment: symptomatic with acetaminophen/NSAIDs extremities more pronounced posteriorly (Figure 1) non-blanching purpura. Some areas of excoriated scrotum,
    [Show full text]
  • Unilateral Giant Varicocele Mimicking Inguinal Hernia Resulting from Portosystemic Shunt Without Evidence of Portal Hypertension: an Unusual Case Report
    Hindawi Publishing Corporation Case Reports in Surgery Volume 2013, Article ID 709835, 3 pages http://dx.doi.org/10.1155/2013/709835 Case Report Unilateral Giant Varicocele Mimicking Inguinal Hernia Resulting from Portosystemic Shunt without Evidence of Portal Hypertension: An Unusual Case Report Muhammed Zahir, Hassan R. Al Muttairi, Surjya Prasad Upadhyay, and Piyush N. Mallick Al Jahra Hospital, Ministry of Health, State of Kuwait, P.O. Box 40206, 01753 Safat, Kuwait Correspondence should be addressed to Muhammed Zahir; [email protected] Received 5 January 2013; Accepted 5 February 2013 Academic Editors: A. Cho, A. K. Karam, Y. Rino, and G. Sandblom Copyright © 2013 Muhammed Zahir et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Isolated giant varicocele has been reported with portal hypertension that results in abnormal communication between portal venous system and testicular vein venous system resulting in retrograde backflow of blood into the testicular venous system which leads to varicosity of the pampiniform plexuses. 65-year-old male with no past medical or surgical history presented to us with soft inguinoscrotal swelling that disappears on lying down mimicking inguinal hernia. Clinical examination revealed soft inguionoscrotal swelling that disappears on pressure. Ultrasonography revealed varicosity of pampiniform plexus, and CT angiography to trace the extent of the varicosity revealed abnormal communication of right testicular vein with superior mesenteric vein. There was no evidence of any portal hypertension; the cause of the portosystemic shunt remains obscure, and it might bea salvage pathway for increasing portal pressure.
    [Show full text]
  • Bilateral Spontaneous Thrombosis of the Pampiniform Plexus; a Rare
    African Journal of Urology (2018) 24, 14–18 African Journal of Urology Official journal of the Pan African Urological Surgeon’s Association web page of the journal www.ees.elsevier.com/afju www.sciencedirect.com Andrology Case report Bilateral spontaneous thrombosis of the pampiniform plexus; A rare etiology of acute scrotal pain: A case report and review of literature a,∗ a a Ktari Kamel , Sarhen Gassen , Mahjoub Mohamed , a b c Ben Kalifa Bader , Klaii Rim , Karim Bouslam , a d a Saidi Radhia , Jelled Anis , Saad Hamadi a Department of Urology, CHU Fattouma Bourguiba, Monastir, Tunisia b Internal Medcine, CHU Fattouma Bourguiba, Monastir, Tunisia c Radiology, CHU Fattouma Bourguiba, Monastir, Tunisia d Physical Medicine, CHU Fattouma Bourguiba, Monastir, Tunisia Received 21 September 2016; received in revised form 12 August 2017; accepted 27 September 2017 Available online 17 February 2018 KEYWORDS Abstract Thrombosis; Introduction: Acute testicular pain is frequent in urology. If torsion of the spermatic cord and orchiepi- Varicocele; didymites are usual, thrombosis of the pampiniform plexus is a very uncommon clinical entity. We present Pain; an unusual case and review the literature to explore potential etiologies and therapeutic strategies. Thrombophilia Observation: A rare case of bilateral thrombosis of the pampiniform plexus occurred in a 39 year-old male.The diagnosis was confirmed with doppler sonographie and Computer Tomography. Urethral infection and protein C deficiency were found as associated factors. The treatment was conservative with good result. Conclusions: Anatomical factors are probably responsible for almost exclusive involvement of the left side. However, coagulation abnormalities and retroperitoneal tumors or absence of inferior vena cava must be sought especially in cases of right side or bilateral thrombosis of the pampiniform plexus.
    [Show full text]
  • Varicocele Embolization– for Patients
    Varicocele Embolization– For Patients What is a varicocele? A varicocele is a network of tangled blood vessels (varicose veins) in the scrotum that is caused by reverse blood flow. Normally, blood in the testicles goes through a series of small veins and is eventually emptied into a large vein that goes up through the abdomen. Sometimes the valves in this vein fail and the blood flows back into the testicles, instead of up to the heart. Varicoceles occur most often in young men in their twenties or thirties and can cause pain, infertility, or testicular atrophy (shrinkage). What are the advantages of varicocele embolization versus varicocele surgery? Unlike varicocele surgery, varicocele embolization requires no incision, stitches, or general anesthesia. Further, embolization patients almost never require overnight admission to the hospital. In addition, several studies have shown that embolization is just as effective as surgery. Studies have also shown that embolization patients return to full activities in a day or two. In one study, patients who underwent both varicocele surgery and embolizaton for varicocele repair, overwhelmingly favored embolization. Should all varicoceles be repaired? Not necessarily. If you have symptoms, such as pain, you may choose to have a varicocele repair procedure sooner. But an asymptomatic varicocele is a common condition that does not necessarily cause pain or infertility. A varicocele only needs to be fixed when it causes pain, shrinkage of a testicle, or when it is associated with male infertility. Will varicocele embolization improve my semen analysis? Many studies have shown that varicocele repair can improve semen analysis significantly, but there is no guarantee that any individual patient will experience a significant improvement.
    [Show full text]
  • Case Report Unilateral Giant Varicocele Mimicking Inguinal Hernia Resulting from Portosystemic Shunt Without Evidence of Portal Hypertension: an Unusual Case Report
    Hindawi Publishing Corporation Case Reports in Surgery Volume 2013, Article ID 709835, 3 pages http://dx.doi.org/10.1155/2013/709835 Case Report Unilateral Giant Varicocele Mimicking Inguinal Hernia Resulting from Portosystemic Shunt without Evidence of Portal Hypertension: An Unusual Case Report Muhammed Zahir, Hassan R. Al Muttairi, Surjya Prasad Upadhyay, and Piyush N. Mallick Al Jahra Hospital, Ministry of Health, State of Kuwait, P.O. Box 40206, 01753 Safat, Kuwait Correspondence should be addressed to Muhammed Zahir; [email protected] Received 5 January 2013; Accepted 5 February 2013 Academic Editors: A. Cho, A. K. Karam, Y. Rino, and G. Sandblom Copyright © 2013 Muhammed Zahir et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Isolated giant varicocele has been reported with portal hypertension that results in abnormal communication between portal venous system and testicular vein venous system resulting in retrograde backflow of blood into the testicular venous system which leads to varicosity of the pampiniform plexuses. 65-year-old male with no past medical or surgical history presented to us with soft inguinoscrotal swelling that disappears on lying down mimicking inguinal hernia. Clinical examination revealed soft inguionoscrotal swelling that disappears on pressure. Ultrasonography revealed varicosity of pampiniform plexus, and CT angiography to trace the extent of the varicosity revealed abnormal communication of right testicular vein with superior mesenteric vein. There was no evidence of any portal hypertension; the cause of the portosystemic shunt remains obscure, and it might bea salvage pathway for increasing portal pressure.
    [Show full text]
  • Transabdominal Pelvic Venous Duplex Evaluation
    VASCULAR TECHNOLOGY PROFESSIONAL PERFORMANCE GUIDELINES Transabdominal Pelvic Venous Duplex Evaluation This Guideline was prepared by the Professional Guidelines Subcommittee of the Society for Vascular Ultrasound (SVU) as a template to aid the vascular technologist/sonographer and other interested parties. It implies a consensus of those substantially concerned with its scope and provisions. This SVU Guideline may be revised or withdrawn at any time. The procedures of SVU require that action be taken to reaffirm, revise, or withdraw this Guideline no later than three years from the date of publication. Suggestions for improvement of this Guideline are welcome and should be sent to the Executive Director of the Society for Vascular Ultrasound. No part of this Guideline may be reproduced in any form, in an electronic retrieval system or otherwise, without the prior written permission of the publisher. Sponsored and published by: Society for Vascular Ultrasound 4601 Presidents Drive, Suite 260 Lanham, MD 20706-4831 Tel.: 301-459-7550 Fax: 301-459-5651 E-mail: [email protected] Internet: www.svunet.org Copyright © by the Society for Vascular Ultrasound, 2019. ALL RIGHTS RESERVED. PRINTED IN THE UNITED STATES OF AMERICA VASCULAR PROFESSIONAL PERFOMANCE GUIDELINE Updated January 2019 Transabdominal Pelvic Venous Duplex Ultrasound PURPOSE Transabdominal pelvic venous duplex examinations are performed to assess for abnormal blood flow in the abdominal and pelvic veins (excluding the portal venous system). The evaluation includes the assessment of abdominal and pelvic venous compressions, abdominal and pelvic venous insufficiency and evaluation of the presence or absence of pelvic varicosities. Note: Abdominal and pelvic venous disorders can be previously referred to as pelvic congestion syndrome or PCS; however, with the expansion of research into the abdominal and pelvic venous system updated nomenclature is imperative to the proper diagnosis and treatment of these conditions.
    [Show full text]
  • Liquid and Solid Embolic Agents in Gonadal Veins
    Journal of Clinical Medicine Review Liquid and Solid Embolic Agents in Gonadal Veins Francesco Tiralongo 1,* , Giulio Distefano 1 , Monica Palermo 1 , Antonio Granata 2, Francesco Giurazza 3, Francesco Vacirca 1, Stefano Palmucci 1 , Massimo Venturini 4 and Antonio Basile 1 1 Radiology Unit I, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia” –University Hospital “Policlinico-San Marco”, University of Catania, Via Santa Sofia n◦ 78, 95123 Catania, Italy; [email protected] (G.D.); [email protected] (M.P.); [email protected] (F.V.); [email protected] (S.P.); [email protected] (A.B.) 2 Nephrology and Dialysis Unit, “Cannizzaro” Hospital, 95123 Catania, Italy; [email protected] 3 Interventional Radiology Department, Cardarelli Hospital of Naples, 80131 Naples, Italy; [email protected] 4 Department of Diagnostic and Interventional Radiology, Circolo Hospital, Insubria University, 21100 Varese, Italyl; [email protected] * Correspondence: [email protected] Abstract: Male varicocele and pelvic congestion syndrome (PCS) are common pathologies with high predominance in young patients, having a high impact on the quality of life and infertility. Lately, the use of different endovascular embolization techniques, with various embolizing agents, shows good technical results and clinical outcomes. With the aim of presenting the “state of the art” of endovascular techniques for the treatment of male varicocele and PCS, and to discuss the performance of the different embolic agents proposed, we conducted an extensive analysis of the relevant literature and we reported and discussed the results of original studies and previous meta-analyses, providing an updated guide on this topic to clinicians and interventional radiologists.
    [Show full text]