Correspondence

Correction

Clinical Problem-Solving: An Anatomy Lesson

N Engl J Med 1994; 331:1660December 15, 1994

Article

To the Editor:

I greatly enjoyed reading “An Anatomy Lesson” by Dr. Duffy (Aug. 4 issue).1 As a resident physician I appreciate and learn a great deal from such practical clinical vignettes.

After outlining the importance of the retroperitoneal lymphatic drainage system of the testicles, however, Dr. Duffy concludes by noting the “anatomical association between the retroperitoneum and the scrotum.” In fact, the lymphatics of the scrotum (along with those of the tunica vaginalis) drain to the superficial inguinal lymph nodes, as demonstrated by the anasarca of elephantiasis. This distinction can be important in differentiating testicular from nontesticular disease in the swollen scrotum.

David C. Youmans, M.D.
776 Berquist Dr., Manchester, MO 63011

1 References

1. 1

   Duffy TP. An anatomy lesson. N Engl J Med 1994;331:318-320
   Full Text | Web of Science | Medline

Author/Editor Response

Dr. Duffy replies:

To the Editor: Dr. Youmans is correct about the pattern of drainage from the scrotum; the text should read “the anatomical association between the retroperitoneum, the contents of the scrotum.” However, the purpose of the “Anatomy Lesson” was not simply to draw the reader's attention to the dissecting-room exercises of long ago but to illustrate that a thorough physical examination, including the genitalia, often provides critical information.

The loss of testicular pain sensation was a clue to tabes dorsalis in the past, and epididymal swelling was suggestive of tuberculosis. Even today, the presence of testicular pain may be the clue to an otherwise occult vasculitis, and the testes remain the site of the most common malignant tumor in young men. The failure to examine the scrotum and its contents may lead one to overlook a finding relevant not only to the retroperitoneum but also to systemic diseases elsewhere in the body.

Thomas P. Duffy, M.D.
Yale University School of Medicine, New Haven, CT 06510

Citing Articles (1)

Citing Articles

1. 1

   B. Diarra, R. Stoppa, P. Verhaeghe, P. Mertl. (1997) About prolongations of the urogenital fascia into the pelvis: An anatomic study and general remarks on the interparietal-peritoneal fasciae. Hernia 1:4, 191-196
   CrossRef