Anterior crural neuralgia as a presenting manifestation of lymphocele

✍ Scribed by Miguel A. González-Gay; Carlos García-Porrúa; José R. Pulpeiro; Francisco Brañas; Luis Mateo-Cambón; Teresa Hernández

• Publisher: John Wiley and Sons
• Year: 2000
• Tongue: English
• Weight: 301 KB
• Volume: 43
• Category: Article
• ISSN: 0004-3591
• DOI: 10.1002/1529-0131(200005)43:5<1183::aid-anr29>3.0.co;2-7

✦ Synopsis

Clinical history

A 72-year-old man was referred to the rheumatology outpatient clinic because of anterior crural neuralgia. Four months earlier, he had been diagnosed as having prostatic cancer. Pelvic lymphadenectomy (which was negative for metastasis) and radical retropubic prostatectomy were performed. Three weeks after surgery, he developed acute pain in the right groin and the medial aspect of the right thigh. Excruciating pain was provoked by walking or by standing in an upright position; however, he was free of symptoms when sitting. Findings of hip and sacroiliac examination were normal, as were findings of an anteroposterior radiograph of the pelvis.

Treatment with analgesics and carbamazepine was prescribed, but there was no improvement of symptoms. A magnetic resonance imaging (MRI) was therefore performed. A mass was observed in close contact with the right sacral plexus, consistent with pelvic lymphocele. Simple percutaneous drainage of the mass was performed. Biochemical and cytologic findings in the aspirated fluid were consistent with lymphocele. The patient experienced a dramatic improvement in symptoms after the fluid was aspirated. However, as expected, the pelvic lymphocele recurred, and surgical marsupialization was performed 4 weeks later. Since then, after 2 years' followup, the patient has remained free of symptoms.