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Kostenko Y, LaGrone L, Cribari C. Acute global testicular infarction: A rare and important complication after endovascular abdominal aortic aneurysm repair. J Vasc Surg Cases Innov Tech 2024; 10:101522. [PMID: 38952999 PMCID: PMC11215112 DOI: 10.1016/j.jvscit.2024.101522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/23/2024] [Indexed: 07/03/2024] Open
Abstract
Testicular ischemia is one of the most rarely reported complications of endovascular abdominal aortic aneurysm repair (EVAR). Although the pathogenesis remains unclear, thromboembolic events in the setting of testicular artery origin occlusion by the stent graft and poor baseline collateral testicular circulation are presumed causes. A 73-year-old man developed acute right testicular infarction 3 days after EVAR, requiring orchiectomy. This case emphasizes the importance of recognizing and evaluating testicular pain after EVAR and counseling patients on this possible EVAR complication.
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Affiliation(s)
| | - Lacey LaGrone
- Trauma and Acute Care Surgery, Medical Center of the Rockies, Loveland, CO
| | - Chris Cribari
- Trauma and Acute Care Surgery, Medical Center of the Rockies, Loveland, CO
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Huang DY, Alsadiq M, Yusuf GT, Deganello A, Sellars ME, Sidhu PS. Multiparametric Ultrasound for Focal Testicular Pathology: A Ten-Year Retrospective Review. Cancers (Basel) 2024; 16:2309. [PMID: 39001372 PMCID: PMC11240835 DOI: 10.3390/cancers16132309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 06/21/2024] [Accepted: 06/22/2024] [Indexed: 07/16/2024] Open
Abstract
Conventional ultrasonography (US), including greyscale imaging and colour Doppler US (CDUS), is pivotal for diagnosing scrotal pathologies, but it has limited specificity. Historically, solid focal testicular abnormalities often led to radical orchidectomy. This retrospective study evaluated the utilisation of contrast-enhanced ultrasound (CEUS) and strain elastography (SE) in investigating intratesticular focal abnormalities. A total of 124 cases were analysed. This study underscored the superior diagnostic capabilities of CEUS in detecting vascular enhancement in all malignant cases, even those with undetectable vascularity by CDUS. It also highlighted the potential of CEUS in identifying distinctive vascular patterns in benign vascular tumours. Definitive confirmation of benignity could be obtained when the absence of enhancement was demonstrated on CEUS. While SE alone offered no distinctive advantage in differentiating between benign and malignant pathologies, we demonstrated that incorporating a combination of CEUS and SE into the evaluation of focal testicular abnormalities could improve diagnostic performance metrics over conventional CDUS. Our findings underscore the role of advanced ultrasound techniques in enhancing the evaluation of focal testicular abnormalities in clinical practice and could aid a shift towards testis-sparing management strategies.
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Affiliation(s)
- Dean Y Huang
- Department of Clinical Radiology, King's College Hospital, London SE5 9RS, UK
- Department of Imaging Sciences, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London SE1 7EH, UK
| | - Majed Alsadiq
- Department of Imaging, The Royal London Hospital, London E1 1FR, UK
| | - Gibran T Yusuf
- Department of Clinical Radiology, King's College Hospital, London SE5 9RS, UK
- Department of Imaging Sciences, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London SE1 7EH, UK
| | - Annamaria Deganello
- Department of Clinical Radiology, King's College Hospital, London SE5 9RS, UK
- Department of Imaging Sciences, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London SE1 7EH, UK
| | - Maria E Sellars
- Department of Clinical Radiology, King's College Hospital, London SE5 9RS, UK
| | - Paul S Sidhu
- Department of Clinical Radiology, King's College Hospital, London SE5 9RS, UK
- Department of Imaging Sciences, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London SE1 7EH, UK
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Rao K, Aswani Y, Priya S, Kemp S, Rajput M. Segmental testicular infarct with an associated testicular artery aneurysm: Case report of a rare clinical entity. Radiol Case Rep 2022; 17:2150-2154. [PMID: 35469300 PMCID: PMC9034288 DOI: 10.1016/j.radcr.2022.02.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 12/02/2022] Open
Abstract
Segmental testicular infarct is a rare clinical entity and can be a diagnostic challenge. Although cases are often idiopathic, underlying etiologies can include testicular torsion, epididymo-orchitis, trauma, vasculitis, and hypercoagulable states. Once suspected, an underlying testicular neoplasm should be excluded. We present a case of a 43-year-old male who developed acute onset left sided scrotal pain. A diagnostic scrotal ultrasound showed a focal, heterogeneous region in left testicle with absent focal Doppler signal, concerning for a segmental testicular infarction. There was no history of trauma, urinary symptoms, sexually transmitted diseases, or constitutional symptoms. Work up for associated underlying etiologies was negative. A computed tomography angiogram scan of the abdomen and pelvis revealed an incidental left testicular artery aneurysm. The patient's consulting multidisciplinary care teams included urology and vascular surgery. Urology deemed surgical intervention inappropriate for the segmental testicular infarct, and vascular surgery elected not to intervene on the testicular artery aneurysm due to risk of completing testicular infarct and damaging blood supply to the testis. The patient was discharged after achieving adequate pain control, and completion of inpatient work up. No underlying malignancy was diagnosed on follow up, and pain symptoms resolved. To the authors’ knowledge, no literature exists describing the concurrent incidence of a segmental testicular infarct and an ipsilateral testicular artery aneurysm. In this report, we aim to further describe both diagnoses, and explore the association between the 2 entities.
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Costa-Perez L, Arefai-Refai B, Ramirez-Montoya M, Hostench-Junoy N. Testicular ischaemia: one of the most unknown of post-EVAR complications. BMJ Case Rep 2021; 14:14/5/e240999. [PMID: 33975838 PMCID: PMC8118061 DOI: 10.1136/bcr-2020-240999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Testicular ischaemia after endovascular aortic aneurysm repair (EVAR) is a very uncommon complication. There are only a few cases reported in the literature and the pathogenesis remains unclear. We report a case of unilateral testicular ischaemia in the early postoperative period after EVAR.A 78-year-old man underwent standard EVAR without immediate complications. Twenty-four hours after the procedure, the patient developed sudden onset of right scrotal pain and a low-grade fever. Urgent testicular ultrasound showed ischaemic signs compromising 75% of the testicle. The patient was successfully managed with conservative treatment.Although the pathogenesis is unknown, acute thrombosis of the testicle feeding arteries is postulated as the main hypothesis in the physiopathogenesis.
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Affiliation(s)
- Laura Costa-Perez
- Servei d'Angiologia i Cirurgia Vascular, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
| | - Bahaa Arefai-Refai
- Servei d'Angiologia i Cirurgia Vascular, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
| | - Mauricio Ramirez-Montoya
- Servei d'Angiologia i Cirurgia Vascular, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
| | - Nuria Hostench-Junoy
- Servei d'Angiologia i Cirurgia Vascular, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
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Zhou YX, Ji Y, Chen J, Yang X, Zhou Q, Lv J. Common iliac artery occlusion with small intestinal transection caused by blunt abdominal trauma: A case report and review of the literature. World J Clin Cases 2019; 7:2120-2127. [PMID: 31423446 PMCID: PMC6695536 DOI: 10.12998/wjcc.v7.i15.2120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 06/22/2019] [Accepted: 07/02/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Most major abdominal vascular injuries are caused by penetrating injuries. A common iliac artery occlusion caused by blunt force trauma is rare, and very few cases have been reported. Because of this low incidence, atypical symptoms, and frequent association with other severe injuries, the proper diagnosis tends to be missed or delayed. The gold standard for diagnosis is angiography, and treatment remains a challenge. CASE SUMMARY We report here the unusual case of a common iliac artery occlusion caused by blunt abdominal compressive trauma, with transection of the small intestine. At presentation, the patient (a 56-year-old man) complained of pain and numbness in the left lower extremity and severe pain in the whole abdomen. Physical examination showed total abdominal tenderness with evidence of peritoneal irritation. The left lower limb was pulseless and cold. Abdominal computed tomography examination revealed digestive tract perforation, and abdominal computed tomography angiography showed left common iliac artery occlusion. The patient was treated successfully by anastomosis of the intestine, percutaneous transluminal angioplasty, and stenting. The patient was followed for more than 11 mo after the operation and showed a good recovery. CONCLUSION Patients with abdominal trauma should be suspected of having major vascular injury. Individualized treatment strategies are needed for this condition.
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Affiliation(s)
- You-Xin Zhou
- Department of General Surgery, People’s Hospital of Jingjiang, Yangzhou University Medical Academy, Jingjiang 214500, Jiangsu Province, China
| | - Yong Ji
- Department of General Surgery, People’s Hospital of Jingjiang, Yangzhou University Medical Academy, Jingjiang 214500, Jiangsu Province, China
| | - Jing Chen
- Imaging Department, People’s Hospital of Jingjiang, Yangzhou University Medical Academy, Jingjiang 214500, Jiangsu Province, China
| | - Xin Yang
- Department of General Surgery, People’s Hospital of Jingjiang, Yangzhou University Medical Academy, Jingjiang 214500, Jiangsu Province, China
| | - Qing Zhou
- Department of General Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang 212000, Jiangsu Province, China
| | - Jian Lv
- Department of General Surgery, People’s Hospital of Jingjiang, Yangzhou University Medical Academy, Jingjiang 214500, Jiangsu Province, China
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Kontopodis N, Kafetzakis A, Kozana A, Tzirakis K, Peteinarakis I, Ioannou CV. Acute Testicular Ischaemia Following Endovascular Aneurysm Repair on the Opposite Side to Intentional Internal Iliac Artery Occlusion. EJVES Short Rep 2019; 43:28-32. [PMID: 31193865 PMCID: PMC6543130 DOI: 10.1016/j.ejvssr.2019.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/16/2019] [Accepted: 04/22/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction Testicular ischaemia is a potential complication after endovascular aneurysm repair (EVAR), which has only rarely been reported in the literature. This is the report of a patient who presented with acute testicular ischaemia in the immediate post-EVAR period. Report A 65 year old patient underwent EVAR for an aortic and bilateral iliac aneurysms. During the procedure, the right internal iliac artery was intentionally occluded to facilitate treatment of the common iliac aneurysm; however, the left internal iliac artery was preserved. The procedure was uneventful. On the second post-operative day the patient gradually developed symptoms of acute left testicular ischaemia. Clinical and ultrasonographic findings constituted the bases of diagnosis and the patient received conservative treatment with gradual improvement. To the authors’ knowledge, this is the ninth case of testicular ischaemia after endovascular aneurysm repair reported in the literature. Conclusion Testicular ischaemia, although rare, is a possible complication post-EVAR. Acute and chronic testicular damage found in association with an abdominal aortic aneurysm or its treatment has not been well studied in the literature and therefore may be under reported.
Acute testicular ischaemia, although rare, may occur in the immediate post-EVAR period. Changes in testicular perfusion caused by AAA and/or EVAR are not well understood and may be under-reported. Distal embolisation or inflow compromise are two possible mechanisms that may result in testicular infarction after EVAR.
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Affiliation(s)
- Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiac, Thoracic and Vascular Surgery, University of Crete Medical School, Heraklion, Crete, Greece
| | - Alexandros Kafetzakis
- Vascular Surgery Unit, Department of Cardiac, Thoracic and Vascular Surgery, University of Crete Medical School, Heraklion, Crete, Greece
| | - Androniki Kozana
- Department of Medical Imaging, University of Crete Medical School, Heraklion, Crete, Greece
| | - Konstantinos Tzirakis
- Biomechanics Laboratory, Department of Mechanical Engineering, Technological Educational Institute of Crete, Estavromenos, Heraklion, Crete, Greece
| | - Ioannis Peteinarakis
- Department of Medical Imaging, University of Crete Medical School, Heraklion, Crete, Greece
| | - Christos V Ioannou
- Vascular Surgery Unit, Department of Cardiac, Thoracic and Vascular Surgery, University of Crete Medical School, Heraklion, Crete, Greece
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