and Jurgen J. Fütterer2, 3
Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, The Netherlands
MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
Sarcoidosis of Genitourinary Tract
Sarcoidosis is considered a multisystem disorder of unclear etiology which can affect many organ, characterized by the presence of widespread, noncaseating granulomas. It is thought to represent a disorder of cell-mediated immunity. It presents a wide spectrum of clinical manifestations and radiographic findings.
Renal involvement is seen in 8–19 % of patients; sarcoidosis may occasionally have a pseudotumors (lymphoma or metastases) appearance with multiple hypodense lesions involving both kidneys. Their similar enhancement to the rest of the kidney on CT or MRI distinguishes them from malignant lesions. The lesion does not usually distort the renal margin. Characteristically, there is central extension of the column of Bertin. Hydronephrosis may be caused by compression of the ureters by enlarged retroperitoneal nodes.
Testicular sarcoidosis has been found in 5 % of patients at autopsy. Testicular sarcoidosis presents with a unilateral, nodular, painless scrotal mass in young males. US is the gold standard; in equivocal cases of epididymal involvement, T2-weighted MRI may reveal a high signal intensity area on a background of normal epididymal tissue.
Sedation for Image-Guided Microsurgery
Two types of medication may be given to patients: one for sedation and anxiety, a mild sedative such as Midazolam, and another for analgesia. In most average-size adult patients, 1 mg intravenously can be given at the onset and then titrate the needs of the patient during the procedure. As a rule it is probably better to err on the side of giving medication, but if there is no apparent need by the history or from clinical observation of the patient, one should withhold the drugs.
Diagnosis of scrotal hernia is usually made on clinically findings, but in rare cases (i.e., patient size, marked enlargement of the scrotum accompanied by acute testicular pain) should be used Magnetic Resonance.
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