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Purpose: We reviewed and analyzed sonographic findings in granulomatous epididymo-orchitis in an attempt to differentiate this rare inflammatory entity from other causes of enlarged scrotum, such as tumors., Materials and Methods: We retrospectively reviewed sonographic features of 9 patients a mean of 41 years old with specific and nonspecific granulomatous epididymo-orchitis, including brucellosis in 7, tuberculosis in 1 and idiopathic granulomatous epididymo-orchitis in 1. Histological confirmation was obtained in 3 cases, and in the remaining 6 positive clinical manifestations and laboratory tests for brucellosis were accepted as the main criteria for the diagnosis of brucellar epididymo-orchitis., Results: The most notable echographic finding was an enlarged and heterogeneous epididymis, predominantly in the body and tail. Testicular involvement consisted of a diffusely hypoechoic testis or focal intratesticular areas. Thickening of the scrotal wall and tunica albuginea, and moderate hydrocele were also noted occasionally. Followup scans revealed intratesticular abscesses in 3 patients., Conclusions: These echographic findings may suggest the diagnosis of granulomatous epididymo-orchitis in the appropriate clinical setting, and help to avoid unnecessary orchiectomy for benign disease.

Purpose: To our knowledge the transrectal ultrasound appearance of prostatic granulomas occurring after intravesical bacillus Calmette-Guerin (BCG) therapy has not been thoroughly described., Materials and Methods: A total of 13 men with a history of transitional cell carcinoma of the bladder treated with intravesical BCG underwent transrectal ultrasound followed by prostate biopsy and/or cystoprostatectomy., Results: Of the 13 patients studied 9 (69.2%) had intensely hypoechoic lesions anteriorly in the transition zone of the prostate on ultrasound images. The lesions were histologically proved to be necrotizing granulomas., Conclusions: Prostatic granulomas secondary to BCG instillation appear as distinct, intensely hypoechoic anterior lesions within the transition zone of the prostate. Prostatic adenocarcinoma arising in the transition zone is usually not visible and would not be easily confused with granulomas. However, since transitional cell carcinoma involving the prostate can appear hypoechoic in the transition zone, transrectal or transurethral tissue sampling may be indicated.

Paravesical granuloma formation after inguinal herniorrhaphy is a rare complication due to infected suture material. We present 8 cases of large paravesical granulomas masquerading as bladder tumors. Irritable symptoms predominate the symptom complex and accurate diagnosis can be obtained with multiple, sonographically guided, needle biopsies of the mass. An operation results in complete resolution of the symptoms, while nonoperative management may help to improve but not resolve the symptoms.

Manifestations of xanthogranulomatous pyelonephritis in 26 patients closely mimicked those of neoplastic and other inflammatory renal parenchymal diseases. Middle-aged or older women were affected most often. Most patients presented with anemia, chronic febrile illness, a painful tender flank mass and recurrent urosepsis. Some features of nephrogenic hepatic dysfunction were present in 13 patients. Bacterial cultures of renal tissue were almost always positive but the spectrum differed considerably from that of the bladder urine. Urographically, a renal mass lesion was encountered in 62% of the patients, nephrolithiasis in 38% and a functionless kidney in 27%. Angiographically, none of the 4 mass lesions studied was distinguished from hypernephroma. Indeed, a correct preoperative diagnosis was made in only 1 instance. There were 3 stages of xanthogranulomatous pyelonephritis recognized. Treatment consisted of nephrectomy for diffuse or advanced stage disease or both (21 patients), excision of the diseased renal segment for localized and low stage disease (2 patients) and renal biopsy (3 patients). Xanthogranulomatous pyelonephritis did not recur but in some patients bacteriuria continued or hypertension developed.

We describe a patient who was referred to our hospital because of dysuria, frequency and a palpable mass in the suprapubic area. A specimen obtained at suprapubic exploration consisted of fatty tissue and tentative diagnosis was pelvic lipomatosis. The symptoms persisted and the entire mass was removed from its prevesical pelvic position. The pathological report was xanthogranuloma. Postoperatively, the symptoms disappeared.

Computerized tomography offers the means to recognize changes in the kidney associated with xanthogranulomatous pyelonephritis. The preoperative extent of the inflammatory process, reaction of adjacent parenchymal structures, and extension to the muscles and abdominal wall are identifiable on computerized tomography. The presence of obstructing renal stones, thickening of the perirenal fascia and inability of the kidney to handle intravenously injected contrast medium can be assessed with computerized tomography. Low density renal areas measured on computerized tomography may indicate lipid infiltration of the kidney or incorporation of the fat of the renal bed into the tumefactive mass.

Xanthogranulomatous pyelonephritis in childhood has been thought to exist only in focal form. We encountered 2 cases of diffuse xanthogranulomatous pyelonephritis in children and have found 3 others reported in the literature, making it necessary to change this concept. The essential radiologic and pathologic differences between focal and diffuse xanthogranulomatous pyelonephritis are reviewed.

Predisposing factors, onset of symptoms to diagnosis interval, computerized tomography findings and the impact of computerized tomography on the outcome were studied retrospectively in 24 patients with renal or perirenal infections. The most common predisposing factors were diabetes mellitus and urinary tract calculi. The mean interval from the onset of symptoms to diagnosis was 6.8 days. The most common computerized tomography findings were thickening of Gerota's fascia, renal enlargement, focal decreased renal attenuation, perirenal fluid and focal gas. Four patients died despite early diagnosis and appropriate therapy. Computerized tomography aided in the diagnosis, assessment of the extent of disease, treatment and followup. Computerized tomography is the most direct method to evaluate patients with suspected renal or perirenal infection, although mortality may not be altered significantly.

The value of corpus cavernosography in the management of conditions other than Peyronie's disease is discussed. The procedure should be done under fluoroscopic control.

Meconium peritonitis results from perforation of the gastrointestinal tract during fetal life. Involvement of the tunica vaginalis may be the sole presenting clinical manifestation of the disease in the unusual event of the gut perforation resolving spontaneously. In such instances radiologically detectable calcification in the abdomen and scrotum is an essential diagnostic point. A case is described in which a baby had hydroceles and bilateral intrascrotal nodules but in which calcification was radiologically undetectable, presumably owing to its having undergon resolution. The typical histology of the nodules provided the diagnosis in this otherwise clinically undiagnostic case.