One of the hallmarks of CAAH is recurrent hemorrhage

One of the hallmarks of CAAH is recurrent hemorrhage. The mechanism of and factors predisposing to recurrent hemorrhage are unclear, but stress conditions may be one of the causes. Surgery for CAAH, one of the major physical stresses, should therefore be reserved for situations where high intracranial pressure cannot be controlled with medical treatment. When decompressive surgery is needed, potential complications (such as bleeding near the operation site or remote area) should be explained to the patient and to his or her next-of-kin. Every effort, such as appropriate sedation, pain relief and blood pressure control, should be made to minimize potential stress during invasive procedures or daily care.
Introduction Testicular torsion is a medical emergency, as it can lead to permanent ischemic injury of the testis involved. The age distribution is bimodal, with two peaks: one in the neonatal PF-573228 Supplier and the other at around 13 years of age. For neonates and young infants, testicular torsion can sometimes be difficult to recognize due to obscure clinical manifestations. Testicular torsion will lead to vascular compromise of the testes if blood flow is not restored in time. There is typically a progressive decrease in testicular volume due to atrophic change, and a small scrotum with disappearance of the testis on the affected side. In the literature, there has been no report mentioning cystic degeneration of the testis after testicular torsion. In this article, we present the rare case of a cystic scrotal mass with atrophic testicular tissue in the wall and yellowish clear fluid in the center, occurring 9 months after testicular torsion.
Case report When he first came to our hospital at 1 year of age, he appeared to be well developed and in good general condition. Physical examination showed an elastic right scrotal mass measuring 3 cm × 2 cm × 2 cm. Sonography revealed a cystic, thick-walled mass in the right scrotum. No testis was identified in the right scrotum (Fig. 1A), but a normal-sized left testis was found. Magnetic resonance imaging (MRI) was performed to check whether there was an intra-abdominal testis; however, no testis was noted along the descending route of the testicle (Fig. 1B). Serum alpha-fetoprotein and beta-human chorionic gonadotropin levels were 7.51 ng/ml and <0.1 mIU/ml, respectively, which were within normal limits. Surgery was performed, and the boy’s right spermatic cord was identified in the inguinal canal. The vas deferens and vessels were less prominent than usual. These structures were directed toward the right scrotal mass. A right scrotal incision was then made, and a cystic mass measuring 3 cm × 2 cm × 2 cm in size was noted (Fig. 2A). The spermatic cord was connected to the mass and the junction between them was constricted. When the cystic mass was opened, some yellowish clear fluid was drained out and the cystic mass collapsed (Fig. 2B). The cyst wall, about 0.6 cm in thickness, was composed of two layers: an outer and an inner. The surface of the inner layer was smooth, containing no residual mass. The mass was left open after biopsy. The patient responded well to the operation and had a smooth postoperative course. Pathological examination of the mass revealed atrophic testicular tissues, with the outer layer of the wall consisting of stromal fibrosis and the inner layer consisting of a few small tubules that were focally filled with small cuboidal cells (Fig. 2C). At follow-up after 1 year, the patient was in good condition.
Discussion Testicular torsion is a medical and urological emergency as it can lead to permanent ischemic injury of the testis involved. Clinical characteristics of testicular torsion include testicular pain that radiates to the groin and lower abdomen with an absent cremasteric reflex. Correct evaluation is often difficult because the clinical manifestations of newborns and young infants are relatively obscure. If blood flow is not promptly restored, testicular torsion will result in vascular compromise of the testis, causing testicular ischemia, infarction and subsequent atrophy. Late presentations of testicular torsion typically show atrophic testicular vessels ending blindly just proximal to the internal inguinal ring, and a vanishing testis inside the scrotum.