Rationale:Most patients with paratesticular rhabdomyosarcoma may typically present as a unilateral, painless palpable scrotum mass. However, only a few cases of RMS presenting as painful edema of the scrotum mimicing epididymitis. We herein report an unusual case of alveolar paratesticular rhabdomyosarcoma misdiagnosed as epididymitis.Patient concerns:A 19-year-old adolescent, presented to urologist with painful swelling of the scrotum on the left side over the preceding several days. Antibiotics were administered by physician for two months and the pain improved, but the swelling did not fade.Diagnoses:Alveolar praratesticular rhabdomyosarcoma.Interventions:A left, soft tissue mass in the scrotum without definite metastasis or lymphadenopathy was confirmed by computed tomography (CT) and magnetic resonance imaging. A radical left orchiectomy via the inguinal approach was performed successfully.Outcome:The patient received 8 cycles of adjuvant chemotherapy, the patient remains recurrence- and metastasis-free at 13 months after surgery.Lessons:When paratesticular RMS is presenting with symptoms of epididymitis, this malignant tumor is usually overlooked. When patients complain of painful scrotal swelling, RMS arise from paratesticular tissue should be considered.

Rationale: As survival prospects improve for long-term patients with hemodialysis, it is common for patients to exhaust all upper extremity access options before other avenues need exploration. The purpose of this case report was to describe our experience in creating a prosthetic graft between left femoral artery and right femoral vein in a patient with history of central venous occlusion and bilateral femoral neck fracture. Patient concerns: A female patient with hemodialysis exhausted all upper extremity access options along with bilateral femoral neck fracture. Diagnoses: Patients with end-stage renal disease exhausted all upper extremity access options. Interventions: We performed a left femoral artery to right femoral vein dialysis access utilizing a prosthetic graft and autologous cephalic vein. Outcome: The graft was used for hemodialysis 3 weeks after the operation. There was no edema of the lower extremity through the immediate postoperative period as well as at follow up. The patient has been using the access for 9 months with no complication of thrombosis, infection, or bleeding. Lessons: Prosthetic graft between the left femoral artery and right femoral vein is a simple, safe and novel approach to creating lower extremity access. This method could be a viable means of hemodialysis access in selected patients.