Vasitis: clinical and ultrasound confusion with inguinal hernia clarified by computed tomography

Abstract

Vasitis or inflammation of the vas deferens is a rarely described condition categorized by Chan & Schlegel 1 as either generally asymptomatic vasitis nodosa or the acutely painful infectious vasitis. Clinically, infectious vasitis presents with nonspecific symptoms of localized pain and swelling that can be confused with other, more common conditions such as epididymitis, orchitis, testicular torsion, and inguinal hernia. Ultrasound with duplex Doppler scanning can be used to exclude epididymitis, orchitis, and testicular torsion. On the other hand, while inguinal hernia is difficult to differentiate from vasitis using ultrasound, computed tomography (CT) is diagnostic. We describe 2 cases of vasitis with clinical and ultrasound findings that initially were interpreted as inguinal hernias. In both patients, CT was diagnostic for vasitis showing an edematous spermatic cord and no hernia. Urine cultures in both patients were negative, but the symptoms resolved with antibiotic treatment.

Acute Vasitis Presenting as an Inguinoscrotal Swelling: A Diagnostic Dilemma

“…The treatment of acute vasitis is mainly antibiotics, though surgical exploration and drainage may be necessary in more severe cases. 1,2,7,8,9,10 Oral antibiotics was sufficient to cause resolution in the index case as there was no need of surgical intervention. The diagnosis of vasitis is complicated by its unclear ultrasonographic findings 2,7,9,10 .…”

“…Tumor within the vas deferens is rare in literature, however there are scanty reports on the inflammation 1 . Two patterns of inflammation had been described; Vasitis nodosa and Acute vasitis 1,2 . Vasitis nodosa is the commonest retrieved from that is reported in the literature.…”

“…We experience a similar situation as computerized tomography scan had to be carried out to make the definitive diagnosis. Computerized tomography scan allowed a formal diagnosis of acute vasitis to be made in most case reports 2,5,6,7,8 . Acute vasitis is often diagnosed at surgery 5,6 .…”

“…Pathogens causing it include Escherichia Coli and Haemophilus influenza 1 . Patients presenting with this condition usually present with a mass in the groin or scrotal spermatic cord 1,2 . We therefore report a case of acute vasitis who presented in the radiology department of a private hospital in Lagos, with a clinical diagnosis of a painful scrotal swelling A 62yr old male presented to us on account of a 4 days history of left groin pain and inguinoscrotal swelling.…”

“…The pathogens commonly associated are Escherichia coli and Haemophilus influenza, however, other rare pathogens such as Brucella and Tuberculosis have also been described 1,3,7,8 . Patients with acute vasitis usually present with a mass in the groin or scrotal spermatic cord1, 2,7,8,9 . This was demonstrated in the index case.…”