Background Acute scrotal pain is a urological emergency. While for testicular torsion and acute epididymitis clinical recommendations are well established, few is known about low incidence causes of acute scrotal pain. Our aim is to identify and characterise rare differential diagnoses of acute scrotal pain in order to give diagnostic and therapeutic recommendations. Materials and methods A systematic literature search was performed in PubMed, Web of Science and the Cochrane Library databases up to February 2019 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. The systematic review protocol was registered on PROSPERO ( CRD42018099472 ). Results Eighty-four publications were selected for analysis. The databases provided mostly case reports, series and small studies, overall reporting on a cohort of 245 cases. Tumors, segmental testicular infarction, testicular vasculitis, pancreatitis, brucellosis, spermatic vein thrombosis, acute aortic syndrome and appendicitis were identified as rare underlying causes of acute scrotal pain and were characterised. As a result of our data analysis we were able to draw an overview of the rare differential diagnoses and diagnostic management of acute scrotal pain. Conclusion Rare differential diagnoses of acute scrotal pain are susceptible to misinterpretation as testicular torsion or acute epididymo-orchitis. Surgical management is indicated in case of suspicion for torsion or tumor. We herein present knowledge of the rare differential diagnoses and raise awareness for associated systemic disease in order to facilitate disease management and increase the potential for testicle-sparing treatment.

What is beyond testicular torsion and epididymitis? Rare differential diagnoses of acute scrotal pain in adults: A systematic review.

Pampiniform plexus thrombosis is a very rare disease (only less than 25 published cases are available till date), and it is a diagnostic dilemma. The present case is an unusual condition of an elderly gentleman who was finally diagnosed as a case of spontaneous thrombosis of bilateral pampiniform plexus and was managed conservatively. Literature was reviewed to explore potential etiologies and therapeutic strategies. A 65-year-old afebrile gentleman, laborer (in brick industry), and non-smoker with no previous major health problems was admitted with swelling in the bilateral inguinal region. The swelling had started one and half months ago. He had developed severe pain over the swelling for last 1 day with tenderness and indurations. Neither he had history of previous surgeries, chronic cough, dysuria, prostatism, and trauma nor he presented any thrombogenic factors. There was no history of vomiting, abdominal pain, and obstipation. Physical examination revealed normotensive person with BMI of 22.5, was significant only for one tender, movable, and firm to hard 10 cm × 3 cm mass extending from the left deep inguinal ring up to the upper pole of the testis in the scrotum. Another 5 cm × 3 cm mass of similar characteristics was found extending from deep inguinal ring up to the root of the scrotum on right side. The testes and prostate were normal on palpation. On the contrary to preoperative USG, which clinched suspicion of incarcerated inguinal hernia, a thrombosed pampiniform plexus without any evidence of hernia sac was found on the left side during inguino-scrotal exploration. Wound was closed without doing any further procedure. Contralateral inguino-scrotal exploration was spared considering same nature of disease. Postoperative Doppler ultrasonography confirmed the diagnosis of bilateral thrombosed pampiniform plexus. MDCT of whole abdomen revealed no abnormality other than bilateral spermatic cord thrombosis. Blood thrombophilia screening came normal. The subject had an uneventful postoperative hospital course. With 2 years of follow-up, the gentleman is doing well, remaining asymptomatic and had returned to his usual life. Due to extreme rarity, spontaneous thrombosis of the pampiniform plexus may be a diagnostic dilemma and requires a high index of suspicion. Doppler ultrasound is the initial investigation of choice. In the absence of other concomitant disease, beginning the treatment conservatively instead of excising the thrombosed segment is more suitable.

/pdf/correction-to-bilateral-spontaneous-thrombosis-of-the-5cgl9i9ulq.pdf

Correction to: Bilateral spontaneous thrombosis of the pampiniform plexus mimicking incarcerated inguinal hernia: case report of a rare condition and literature review.

Acute scrotum considered to be a common and one of the urological top emergency cases. However, acute testicular pain due to testicular vein thrombosis is rare especially if this thrombosis considered to be a complication of an infection, and not due to varicocele or malignancy-related conditions. A rare case of right epididymo-orchitis case complicated by right pampiniform plexus thrombosis, which resolved spontaneously with no anticoagulant management., Testicular vein thrombosis considered to be a rare differential diagnoses of acute scrotum presentation. With a limited number of reported cases, it requires more evaluation to develop a proper medical approach.

Acute right epididymo-orchitis complicated by pampiniform plexus thrombosis.

Pampiniform venous plexus (PVP) thrombosis is exceedingly rare, with fewer than 25 cases described. Thus, the etiology and pathophysiology remain largely unknown. A 38-year-old male with no known risk factors incidentally noted a 10-day history of right testicular discomfort prompting evaluation. Findings included extensive right PVP thrombus, critically elevated hematocrit, and a JAK2 V617F gene variant. Despite no treatment guidelines, conservative management was initiated with therapeutic apixaban, and therapeutic phlebotomy and hydroxyurea for newly diagnosed primary polycythemia vera (PV), sparing exploratory genitourinary surgery. This represents the first reported case of PVP thrombosis as the initial manifestation of a JAK2 V617F positive PV and the first documented report of PVP thrombosis associated with an acquired hypercoagulable state. Of the 8 previous cases with hypercoagulable testing performed, 2 involved inherited hypercoagulable states, suggesting hereditary and acquired prothrombotic disorders should be considered as predisposing factors. Testing for the JAK2 V617F variant in patients with mesenteric, cerebral, and splanchnic venous thromboses is currently recommended, but testing patients with venous thromboses in other anatomical locations remains controversial. We reviewed all previously described cases to expound upon this diagnosis, potential association with hypercoagulable disorders, treatment options, and observed clinical outcomes. This case adds to the minimal literature and supports genetic testing all patients with spontaneous PVP thrombosis for the JAK2 V617F variant and other hypercoagulable conditions. Additionally, conservative management with therapeutic anticoagulation and treatment of the underlying precipitating disease state may be acceptable in select patients, following exclusion of surgical emergencies.

The first report of a JAK2 V617F-positive myeloproliferative neoplasm with initial manifestation as a rare pampiniform venous plexus thrombosis and review of the literature.

ObjectivesThe dilatation of the pampiniform plexus, the venous system that drains the testicle, causes varicocele. Varicocele thrombosis is rare, with few reported cases in the medical literature [1-6]. Patients may present with acute scrotal pain, mimicking a testicular torsion or strangulated hernia. Diagnosis is difficult, therefore, when based solely on clinical history and examination. Our objective is to present an unusual case of varicocele thrombosis, after Covid 19 vaccination.MaterialsUltrasonography (US) with Doppler interrogation is the first-line imaging choice for diagnosis [1]. The therapeutical management is primarily conservative; however, some cases might require surgery [1,6]. The Coronavirus 2019 pandemic stimulated the development of vaccines with unprecedented speed and employing novel technologies. Serious adverse effects remained low after worldwide vaccination [7,8].ResultsWe report the case of a 35-year-old male patient who presented in the Urology Department accusing intense, continuous scrotal pain and swelling, with onset the next day after receiving the second dose of an mRNA Covid-19 vaccine (BNT162b2, Cominarty, Pfizer/BioNTech). There were no associated urinary signs and no fever. The patient was a healthy young man, with no known malignancy or blood dyscrasia. He could not recall suffering any local trauma between the vaccination and the appearance of the symptoms.The clinical exam revealed a tender, scrotal swelling inferior to the left testicle.The ultrasound exam demonstrated homogenous, normal echogenic testicles without changes in vascularity on Doppler US. Multiple variceal dilatations with a spontaneous diameter of up to 5 mm were observed around the left testis. The lumen of several dilated veins appeared filled with echogenic debris. The blood flow was slow in the remaining veins, with a sluggish aspect. Continuous, progressive probe compression was applied, with no complete venous collapse observed. The greyscale aspect was consistent with partially obstructing thrombi. The venous filling defects were confirmed on Colour Doppler. No signs of thrombosis were present at the level of the spermatic cord or the inguinal canal.ConclusionsPampiniform plexus thrombosis should be considered in the differential diagnosis of acute testicular pain.This case report reveals an unprecedented etiology of varicocele thrombosis, as a side effect of an mRNA SARS-COV2 vaccine. The dilatation of the pampiniform plexus, the venous system that drains the testicle, causes varicocele. Varicocele thrombosis is rare, with few reported cases in the medical literature [1-6]. Patients may present with acute scrotal pain, mimicking a testicular torsion or strangulated hernia. Diagnosis is difficult, therefore, when based solely on clinical history and examination. Our objective is to present an unusual case of varicocele thrombosis, after Covid 19 vaccination. Ultrasonography (US) with Doppler interrogation is the first-line imaging choice for diagnosis [1]. The therapeutical management is primarily conservative; however, some cases might require surgery [1,6]. The Coronavirus 2019 pandemic stimulated the development of vaccines with unprecedented speed and employing novel technologies. Serious adverse effects remained low after worldwide vaccination [7,8]. We report the case of a 35-year-old male patient who presented in the Urology Department accusing intense, continuous scrotal pain and swelling, with onset the next day after receiving the second dose of an mRNA Covid-19 vaccine (BNT162b2, Cominarty, Pfizer/BioNTech). There were no associated urinary signs and no fever. The patient was a healthy young man, with no known malignancy or blood dyscrasia. He could not recall suffering any local trauma between the vaccination and the appearance of the symptoms. The clinical exam revealed a tender, scrotal swelling inferior to the left testicle. The ultrasound exam demonstrated homogenous, normal echogenic testicles without changes in vascularity on Doppler US. Multiple variceal dilatations with a spontaneous diameter of up to 5 mm were observed around the left testis. The lumen of several dilated veins appeared filled with echogenic debris. The blood flow was slow in the remaining veins, with a sluggish aspect. Continuous, progressive probe compression was applied, with no complete venous collapse observed. The greyscale aspect was consistent with partially obstructing thrombi. The venous filling defects were confirmed on Colour Doppler. No signs of thrombosis were present at the level of the spermatic cord or the inguinal canal. Pampiniform plexus thrombosis should be considered in the differential diagnosis of acute testicular pain. 

Acute varicocele thrombosis after vaccination with mrna sars-cov-2 vaccine- a case report

https://www.ajol.info/index.php/aju/article/download/169868/159309

Bilateral spontaneous thrombosis of the pampiniform plexus; A rare etiology of acute scrotal pain: A case report and review of literature

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Bilateral spontaneous thrombosis of the pampiniform plexus; A rare etiology of acute scrotal pain: A case report and review of literature