Despite the vulnerable position of the testicles, testicular trauma is of hematocele, obvious testicular fracture planes, or disruption of the. Scrotal haematocoeles are collections of blood within the scrotal sac, but outside of the testis. Pathology A haematocele normally results from trauma to the. The differential diagnosis with a testicular tumour can become very of an idiopathic hematocele, which was mistaken for a testicular cancer.

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Diagnosis and classification of inguinal hernias. Edit article Share article View revision history. Long-standing hematoceles easily become hematocdle and fibrotic, becoming firm and painless masses. Unlike the pain of testicular torsion, the pain of orchitis is usually relieved by elevation of the testes.

Inguinal hernia, hydrocele, and the undescended testis. The pathological diagnosis was chronic organized hematocele. Patient history is usually very helpful for the diagnosis, especially in cases of previous trauma.

During fetal development, the processus vaginalis testis forms as an extension of the peritoneum, descending into the scrotum and surrounding the testis.

Testicular trauma is the most common cause of hematocele and the third most common cause of acute scrotal pain. A clinical differential would be for a scrotal wall hematoma. Such a condition is rather associated with testicular torsion in the peripuberal period the other peak of testicular torsion incidence occurs in the perinatal period 2. When cancer is suspected, the physician should explore surgically. Observe the physiological amount of fluid within the left scrotum.


Idiopathic or spontaneous hematoceles give a history of neither trauma to the testis,nor pain in the organ and seems to be more common in elderly patients1,9.

Most frequently, testiculaf occurs as a complication of orchiepidydimitis, particularly in cases where the latter crosses the mesothelial layer of the tunica vaginalis 3or secondarily to a reactive infected hydrocele 6. The left spermatic cord was swollen; the testis, together with its mass, was very difficult to isolate and detach from the dartoic layers.

Evaluation of Scrotal Masses – – American Family Physician

See My Options close. Some differential diagnoses must be taken into consideration, namely, indirect inguinal hernia, where the presence hesticular fluid and gas involved by the bowel loop wall is observed Figure 7 ; spermatocele, located in the epidydimal head and containing small, fluctuating echoes corresponding to spermatozoids Figure 8 ; and acute hematoceles and pyoceles.

The histopathological diagnosis teeticular an organized hematocele, and the left testis was located separately from the mass, having normal appearance. Fournier’s gangrene, necrotizing and potentially fatal perineal infection. Additionally, large collections make the tunica albuginea identification more difficult at US and may lead to false-negative diagnoses of intratesticular hematoma where, in fact, hematocele is present 2.

A varicocele is a dilation of the pampiniform venous plexus along the spermatic cord. Case 1 A 29—year old baseball player presented to the emergency department 6 hours after he was hit in the scrotum with a baseball. If torsion is suspected, surgical consultation should be obtained concurrently with ultrasonography, because the ability to successfully salvage the affected testis declines dramatically after six hours of torsion.

Support Center Support Center. The pain radiates to the inguinal and hypogastric areas and may be accompanied by nausea and vomiting.


A malignancy must be always ruled out when a firm mass is discovered within testicular parenchyma.

Strangulated hernias are a surgical emergency. He had no history of genital trauma, nor did he complain about any other symptoms.

The strange case of a hematocele mistaken for a neoplastic scrotal mass

Blood test results were normal, including testicular markers beta-human chorionic gonadotropin [beta-HCG], alpha-fetoprotein [alpha-FP], and lactase dehydrogenase [LDH]. Surgical evacuation of the hematoma can prevent complications of a hematocele like compression of testis, abscess formation or necrosis, as unresolved hematocele can eventually be infected.

If testicular torsion is suspected, emergent surgical consultation with or without Doppler ultrasonography should be obtained. Synonyms or Alternate Spellings: Diagnosis and treatment of the acute scrotum. However, a hydrocele may appear at any age as a painless, unilateral scrotal swelling of acute or insidious onset. In our case, where the ultrasound was inaccurate, the MRI was useful in the diagnosis.


Such collections are caused by hesticular factors ranging from physiological events to varied diseases. Epididymitis, acute infection of the epididymis, is usually caused by sexually transmitted diseases or common genitourinary pathogens, including gonorrhea and chlamydia. Orchitis can occur when organisms travel up the vas deferens from the urinary tract, or it can be caused by systemic infections; potential pathogens include chlamydia, salmonella, mumps, brucellosis, and tuberculosis.

The left testis was not evaluable morphologically.