臨床上與疝氣易混淆之精索炎 – 影像案例報告

林崇裕¹、林君軒¹、黃琮懿¹

高雄醫學大學附設醫院 泌尿部¹

Vasitis: a clinical confusion diagnosis with inguinal hernia

Chung-Yu Lin¹, Chunhsuan Lin¹, Tsung-yi Huang¹

Divisions of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan ¹

Abstract：

A 39-year-old man with right inguinal hernia post operation during infancy presented with right groin and scrotum tenderness for two days. He denied fever, urinary tract symptoms or previous sexually transmitted infections. Physical examination revealed a tender and palpable inguinal mass extending from the external inguinal region to the scrotum. Laboratory examination revealed leukocytosis (11.63x1000/uL) and elevated C-reactive protein level (13.09 x mg/L). Urinalysis revealed sediments of white blood cell (25-50/HPF). Sonography revealed normal and symmetrical testicular sizes and blood flow. Under the suspicion of incarcerated inguinal hernia, computed tomography (CT) was arranged, which revealed prominent thickening of the right spermatic cord and vas deference with edematous changes and peripheral fat stranding. Empirical antibiotic treatment (ciprofloxacin) was initiated with a favorable course. On follow-up 3 months after discharge, he remained asymptomatic and pain-free.

Infectious vasitis can be difficult to distinguish from incarcerated inguinal hernia in clinical and ultrasonography findings, as both present with groin masses and pain. Laboratory results were usually normal or a slightly elevated white blood count. In the few infectious vasitis cases described, imaging was not used and the patients were treated surgically for suspected inguinal hernias, but no hernia was found. In the present case, CT was used to differentiate between inguinal hernia and vasitis.