0521779407-16 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18
Orbital Tumors Orchitis and Epididymitis 1089■Non-invasive imaging studies (CT, MRI, rarely ultrasound)
■CT direct fine needle biopsy has >98% accuracy.
differential diagnosis
■Most common cause of unilateral/ bilateral adult proptosis is thyroid
orbitopathy:
■In younger adults, orbital proptosis is usually due to a benign process
■Differential diagnosis includes a gamut of benign and malig-
nant processes: inflammatory, vascular lesions (cavernous heman-
giomas) benign mesenchymal tumors, idiopathic lymphoid/ inflam-
matory process, and malignancies.
■Orbital lymphoma may be the first sign of systemic lymphoma.
■5–10% of orbital turnefactions in older age groups are orbital metas-
tases that may be the initial presentation of a lung, renal or gastroin-
testinal malignancy.
management
■Surgery, radiation, less commonly chemotherapy, depending on his-
tology.
■Specific therapy depends on the histology and known therapy
response.
specific therapy
n/a
follow-up
■Follow-up is predicated in the histology of the lesion.
complications and prognosis
n/aORCHITIS AND EPIDIDYMITIS
JAMES W. SMITH, MD and DANIEL BRAILITA, MD
history & physical
History
■Patients with epididymitis and orchitis present with recent onset of
painful swelling of the scrotum.
■Infection can follow sexually transmitted diseases such as urethritis
in patients <35 years of age.
■In patients >35 years of age, bacterial infection of urinary tract with
enteric pathogens is most frequent.