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IMAGING FOR RESIDENTS ANSWER Table of Contents  
Ahead of print publication
A male patient with left inguinal bulge and left scrotal pain


 Department of Radio-Diagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India

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Date of Submission14-Dec-2020
Date of Decision23-Feb-2021
Date of Acceptance11-Mar-2021
Date of Web Publication02-Jul-2021
 


How to cite this URL:
Phatak SV, Manoj M, Jain S, Harshith Gowda K B. A male patient with left inguinal bulge and left scrotal pain. J Med Ultrasound [Epub ahead of print] [cited 2021 Oct 26]. Available from: http://www.jmuonline.org/preprintarticle.asp?id=320548





  Section 2 – Answer Top


Case

A 57-year-old male presented with complaints of dull aching pain in the left scrotum and a bulge in the left inguinal region. There was no history of trauma or fever. Ultrasound (US) examination of the inguinoscrotal region was performed [Figure 1], [Figure 2], [Figure 3].
Figure 1: Grayscale ultrasonography image of the left scrotal sac shows free fluid and a hyperechoic structure with posterior acoustic shadowing

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Figure 2: Grayscale ultrasonography image of the left scrotal sac shows a well-defined anechoic structure of size 5.2 mm × 5.1 mm with posterior acoustic enhancement in the head of the epididymis

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Figure 3: Grayscale ultrasonography image of the left inguinal region shows hyperechoic fat-containing omentum into the inguinal canal

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Interpretation

US images of the left scrotal sac showed an incidental finding of a hyperechoic structure with posterior acoustic shadowing [Figure 1], which is consistent with a diagnosis of scrotolith. Other findings include an epididymal cyst [Figure 2] and an inguinal hernia with omentum as its contents [Figure 3].

Scrotoliths (scrotal pearls) are extratesticular calcifications within the scrotum which occur due to microtrauma to the scrotum. They are found within the layers of tunica vaginalis. Their prevalence is estimated to be approximately 3%.[1] They are asymptomatic and are diagnosed as an incidental finding on US. Small calcifications can present without posterior acoustic shadowing. Repeated microtrauma to tunica vaginalis and scrotal wall leads to abnormal accumulation of cholesterol and calcium minerals which leads to the formation of stones. On US, they are seen as free-floating echogenic foci measuring <10 mm in size. They are more apparent in the presence of hydrocele.

Epididymal cysts are the most common intrascrotal cystic lesions. They are seen as well-defined anechoic structures with posterior acoustic enhancement at the upper pole of the testis. Large cysts can also present with internal septations and internal debris within.[2]

Inguinal hernias can present with bowel or omentum as its contents. Omentum is seen on ultrasonography as a hyperechoic well-defined lobulated structure.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Artas H, Orhan I. Scrotal calculi. J Ultrasound Med 2007;26:1775-9.  Back to cited text no. 1
    
2.
Valentino M, Bertolotto M, Ruggirello M, Pavlica P, Barozzi L, Rossi C. Cystic lesions and scrotal fluid collections in adults: ultrasound findings. J Ultrasound 2011;14:208-15.  Back to cited text no. 2
    

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Correspondence Address:
Suresh V Phatak,
Department of Radio-Diagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Sawangi, Wardha - 442 001, Maharashtra
India
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Source of Support: None, Conflict of Interest: None



    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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