Imaging modalities for an uncommon inguinal scrotal pathology: A case report and literature review

Abstract

Inguinal scrotal swelling is a common presentation to surgical clinic with various differential diagnoses. In most circumstances, a good clinical assessment is sufficient to identify the diagnosis. Imaging is necessary when diagnostic difficulty was encountered. The choice of imaging study could affect the management and outcome. A 60-year-old male presented with an enlarging right inguinal scrotal swelling for 5 years. Clinical examination showed a swelling extended from the right inguinal region down to the right scrotum, firm, not reducible, and not separable from the right testis. Differential diagnoses range from the malignant testicular tumor, irreducible inguinal hernia to the soft-tissue tumor. Ultrasonography and computed tomography scan were unable to conclude the origin of the tumor and involvement of the right testis. Inguinal exploration with potential radical orchiectomy was planned and caused much distress to the patient, resulted in delay in surgery. Intraoperatively, the mass was separated from the testis and spermatic cord, and thus, excision biopsy was performed sparing the testis and spermatic cord. Histopathological examination showed cellular angiofibroma. The right choice of imaging modality is important to provide a precise diagnosis and better treatment plan. This could avoid the unnecessary distress to the patient for potential organ lost. A review through the literature showed the ability of magnetic resonance imaging to better delineate the anatomy of inguinal scrotal soft-tissue mass and thus should have been the imaging modality of choice.

Penetrating Scrotal Injury: Two Unusual Case Reports in Children and Brief Review of Literature

“…Scrotal trauma is rare surgical emergency that accounts for less than 1% of all traumatic injuries, largely because of the safe anatomical location and mobility of the scrotum [1]. These injuries are predominantly more prevalent in 15-40 years age group [2].…”

“…There are various mechanisms of scrotal trauma, of which blunt trauma is the commonest form. Blunt scrotal trauma contributes to about 80% of all scrotal injuries [1]. In children, most blunt scrotal trauma occurs most commonly among 6 to 12 year old boys with typical mechanisms including falls or kicks during sports and injuries from bicycle or motor vehicle collisions [3,4].…”

“…In children, most blunt scrotal trauma occurs most commonly among 6 to 12 year old boys with typical mechanisms including falls or kicks during sports and injuries from bicycle or motor vehicle collisions [3,4]. Penetrating trauma also contributes to about 20% of scrotal injuries [1]. However, penetrating scrotal injuries are rare in children but can occur from bicycle handlebars, falls with impalement and animal bites [5,6].…”