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What Does The USG Report Indicate?

Posted on Wed, 23 Apr 2014

Question: hi Doctor, My son aged 4 years , have observed swelling above right testicular.consulted pediatric doctor, had USG, reports are like this... 1.Both testis are seen to be in their normal location in the scrotal Right 19 X 8 X12 Left 16 X 9 X12 2.Testicular parenchymal echogenicity and vascularity appear normal, with no focal lesions noted with in. 3 Right epididymis measures 6 X7 mm and shows a large epididymal cyst measuring 17 X 29 with floating internal echoes. left epididymis measures 5 X 7mm normal. 4. No evidance of hydrocele or varicocele noted on either side. pediatric doctor consulted related surgon , he suggested wait 2 weeks and consult back, not given any medicine. kindly suggest on this problem.

Answered by Dr. Deepak Kishore Kaltari (22 minutes later)

Brief Answer: Antibiotics and repeat Ultrasound Detailed Answer: Hi Welcome to Healthcare-Magic Greetings of the day Namasthe Dear Mr XXXXXXX Komma The cyst in the epididymis is roughly 1.7* 2.9 cm. Presence of internal echoes signifies debris which is likely to be pus. So it is suggestive of infected epididymal cyst or small Pyocele( Pus containing collection present around epididymis). In my clinical practise , I put the children on 7 day course of antibiotic and anti-inflammatory . In majority of the cases it has resolved. I also do a follow-up Ultrasound for reassessment after 3 weeks of the episode. I would also suggest the same. Presently if there is no pain, fever and no urinary complaints then there seems to be no cause for concern. Do write directly to me if you need any further assistance, will be glad to assist and will be my privilege. Take Care Best regards Dr Deepak Kishore MBBS,MS,MCH Consultant Pediatric Surgeon

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Deepak Kishore Kaltari (2 hours later)

Hello Dr XXXXXXX XXXXXXX Thanks for your reply, Forgot to mention 5 days history . 1. Pediatric Doctor-1 (near to home). sunday (15 th march) he had cold,fever around 100 and body pains. started Meftal-P and Piriton cs. fever will come down once had syrup, after 3 hrs agian fever, still yesterday night (March 18) same problem , swelling noticed testicles on yesterday night.not sure from how many days that swelling was there.because we have not noticed and he never told pain. from today morning no fever only cold and dry cough. 2. Pediatric Doctor - Apollo. Today after noon ,consulted doctor at Apollo, doctor told fever because of cold , she had asked to take X-ray of nose,it observed adenoid enlargement .she told fever because of this, not because of testicles swelling ( the problem mentioned previously ), she discussed with pediatric surgeon (as mentioned previously ) and suggested antibiotic " Augmentin DDs" for 7 days course( consult surgeon after 2 weeks) and cough syrup and nose drops. Kindly provide your opinion and suggestion for taking next step. Thanks & Regards XXXXXXX

Answered by Dr. Deepak Kishore Kaltari (7 minutes later)

Brief Answer: Repeat scan after 3 weeks Detailed Answer: Namasthe Dear Mr XXXXXXX The amount of infected collection in testis is very small to cause fever. Cause of fever is likely to be Upper respiratory tract infection. Adenoid enlargement is quite common in children, the size gradually regresses. As previously mentioned, continue antibiotics and reassessment by Ultrasound after 3 weeks(individual policy vary). Apart from antibiotic and cough syrup i would advise you following 1. Steam Inhalation: Preferably using electric steamer. It reduces airway inflammation and provides much symptomatic relief 2. Decoction: To a cup of milk+10 tulsi leaves+2gm fresh ginger+2 black pepper+ 1 spoon turmeric+ sugar as per taste. Boil it and filter it. Give him hot to drink. Its beneficial for enlarged adenoids. ontinue giving him 1 cup everyday even after symptoms resolve. There is no cause for concern. Take Care Best Regards Dr Deepak

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Deepak Kishore Kaltari (37 hours later)

Hi Doctor, Thank you very much for providing valuable information and suggestions. May I know the reasons why this testicle swelling(epididymal cyst ) problem comes in children. is there any surgery required for this problem? started wearing under wares. what are all the precaution to be taken Kindly provide your inputs. Thanks & Regards XXXXXXX

Answered by Dr. Deepak Kishore Kaltari (1 hour later)

Brief Answer: wearing right size underwear important Detailed Answer: Namasthe Dear Mr XXXXXXX The seminiferous tubules of testis join to each other and enter the vas deferens ( tube like structure which transmits sperm from testis to urethra). If some of the tubules in the epididymis there is accumulation of secretion it causes epididymal cyst. It may get infected causing such picture. In majority of cases it resolves with antibiotics and good scrotal support. Need for surgery is assessed on reevaluation scan . Wearing right size underwear which neither loose nor tight is important. I hope I have resolved your doubts. Do write directly to me for any further information. Take care Best Regards Dr Deepak

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Deepak Kishore Kaltari (13 days later)

Hi Doctor XXXXXXX We have consulted Pediatric Surgeon, after observing the testicles , he told that it looks like, some fluid, reason like , connection from tummy to the testicle part is not closed after birth. He suggested to take USG. The results are like this , kindly provide your suggestion. Observation: USG - SCROTUM Both testis are seen to be in their normal location in the scrotal sac. Right testis measures ~ 16 x 8 mm. Left testis measures ~ 15 x 6 mm. Evidence of well defined anechoic lesion measuring ~ 36 x 18 mm above right testis extending up to the right inguinal canal and two loculations seen one near the inguinal canal ~ 8 x 4 mm and another above the right testicular region ~ 10 x 4 mm. No evidence of internal echoes. No evidence of bowels. Right testis and epididymis looks normal. Left testicular parenchymal echogenicity and vascularity appear normal, with no focal lesions noted within. Left epididymis appears normal. IMPRESSION: Features suggestive of persistent processus vaginalis with loculations as described above. Thanks & Regards XXXXXXX

Answered by Dr. Deepak Kishore Kaltari (11 minutes later)

Brief Answer: Its Infantile Hydrocele Detailed Answer: Namasthe Greetings Its Infantile Hydrocele. There is peritoneal fold extending from the abdomen through the abdomen wall, inguinal canal and base of scrotum. Presence of this persistent fold is known as Patent processus Vaginalis. Fluid can accumulate in it and cause Hydrocele. It will require Surgery which is day care procedure. Its Inguinal Herniotomy, in which the patent processus vaginalis is disconnected from the scrotal sac by ligating it at Deep inguinal ring. It will not resolve with time and medication. Do get back to me if you need any further assistance. Take Care Regards Deepak

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Deepak Kishore Kaltari (21 minutes later)

Thanks a lot for providing clear information doctor. In feature is there any problem after having surgery. Is there any other things we have to ask doctor before taking surgery. Is it urgent to be operated ? can we fix surgery after 1 week or 10 days? Please provide your inputs. Thanks & Regards XXXXXXX

Answered by Dr. Deepak Kishore Kaltari (16 minutes later)

Brief Answer: Its a routine surgery Detailed Answer: Namasthe Dear Bro Its a routine and minor Pediatric Surgical procedure. There will be no problem after surgery. Hydrocele is not emergency surgery. It can be operated a per convenience of parents. No hurry. Settle down the things at home taking your own time and you can fix up the appointment. 1 week, 1 month , 2 month is also acceptable. Need for surgery is because it will not resolve on its own. Take Care With regards Deepak

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Deepak Kishore Kaltari (17 minutes later)

Dear Dr XXXXXXX Thanks for providing quick response always. you have provided very useful information and also your answers made me like I have consulted personally. Will get back to you If I have any queries again. Thanks once again. Regards XXXXXXX

Answered by Dr. Deepak Kishore Kaltari (21 minutes later)

Brief Answer: Take Care Detailed Answer: Thanks bro Take Care God bless you and your family Deepak

Note: For further inquiries on surgery procedure and its risks or complications book an appointment now

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar