Subcutaneous cervicofacial emphysema following thyroid surgery

imaging. Two cases had ultrasound reporting an inguinal hernia prior to vasitis being confirmed on CT scan. CT or magnetic resonance imaging are the suggested imaging modalities to confirm vasitis. A CT scan for vasitis characteristically shows a thickened and oedematous unilateral spermatic cord without an inguinal hernia containing bowel. None of the 10 cases record positive non-STI urine culture, despite urinary pathogens being the suspected cause. Two case reports that were taken to theatre record positive tissue culture for non-haemolytic streptococci and Escherichia coli. Dylewski and Sygal’s study was the first vasitis case to isolate C. trachomatis on urine PCR. We report the first case of C. trachomatisand N. gonorrhoeaeassociated vasitis confirmed on swab and urine PCR analysis. In our case, a high suspicion of an STI was likely given recent dysuria with penile discharge and history of polygamous unprotected intercourse. Typically, epididymo-orhchitis would be suspected, although this picture was obscured by his examination of a irreducible inguinal lump. Ultrasound further confused the clinical picture, reporting normal testes and bowel containing inguinal hernia. Thankfully, CT clarified the diagnosis as vasitis. Given the difficult clinical diagnosis of vasitis and the inaccuracy of ultrasound in our case as well as others, we would advocate the use of a CT scan, when acutely available, to potentially avoid surgical exploration.