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Practice Interactive case report

70 year old man with scrotal swelling, abdominal aortic aneurysm, and renal lesions: case report

BMJ 2006; 332 doi: (Published 13 April 2006) Cite this as: BMJ 2006;332:899

neoplastic disease needs to be excluded.

1. The description of the left renal cyst makes me suspicious of a
neoplasm and i would want further detailed imaging (ct scan) and tissue
biopsy if possible. Polcystic disease could account for the right renal

2.Compression of the left renal vein can result in varicoele and this may
again point towards a renal cell neoplasm. The right sided scrotal
hydrocele could be incidental or possibly indicative of metastatic spread?
I wonder if he is infact currently asymptomatic of the abdominal aortic

3. i would want the following first line investigations
imaging-ct abdomen
blood tests ue creatinine lft fbc tft psa. tumor markers such as afp cea-
125 could also be considered if neoplastic disease is confirmed and
primary site is unclear on tissue biopsy. i would also consider cytology
and culture and sensitity on hydrocele fluid.

Competing interests:
None declared

Competing interests: No competing interests

20 April 2006
james v coady
gp locum
fraserburgh scotland iv31 6an