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Tension hydrocele as an additional cause of acute scrotum: case series and literature review

  • Jeries P. ZawaidehEmail author
  • Michele Bertolotto
  • Massimo Giannoni
  • Giovanni Piaggio
  • Felice Durand
  • Lorenzo E. Derchi
Special section: Male pelvis
  • 27 Downloads

Abstract

Purpose

To describe the correlation between acute scrotum pain and tension hydrocele, focusing on US and Doppler features.

Methods and materials

We evaluated retrospectively a series of five patients with a long history of hydrocele who were referred to our institutions for increasing acute scrotal pain. Patients were approached with gray scale US of both testes, as well as with color-Doppler and spectral analysis, comparing the results with those after aspiration and symptoms relief.

Results

All patients had a “simple” hydrocele with no internal septa; the involved testicles had a “flattened” appearance and parenchymal Doppler signals showed increased intratesticular vascular resistance. One patient had a low diastolic flow, compared to the contralateral testis, with an increased RI value, one had no diastolic flow, two patients had retrograde diastolic flow, and the remaining one had no intratesticular flow visible. After decompression, there were disappearance of pain and improved flow with normalization of testicular vascularity; post-ischemic hyperemia was appreciated in the two patients examined immediately after fluid aspiration, while normal flow was seen in three studies carried out the day after.

Conclusion

To conclude, tension hydrocele is a rare condition that produces alterations of form and circulation of testicles, increase of intraparenchymal vascular resistances and strong and continuous pain, mimicking a testicular torsion. The increase in pressure produces an effect similar to that observed in a compartment syndrome. US findings, together with clinical assessment, indicate when emergency decompression may be appropriate to relieve testicular ischemia.

Keywords

Acute scrotum Hydrocele Doppler ultrasound 

Notes

Funding

All the authors did not receive any economical founds.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Health Sciences (DISSAL), Radiology SectionUniversity of GenoaGenoaItaly
  2. 2.Department of RadiologyUniversity of TriesteTriesteItaly
  3. 3.Emergency Radiology, Policlinico San Martino HospitalGenoaItaly
  4. 4.University of GenoaGenoaItaly
  5. 5.Department of UrologyPoliclinico San Martino HospitalGenoaItaly
  6. 6.Department of Health Sciences (DISSAL)University of Genoa, Emergency Radiology, Policlinico San Martino HospitalGenoaItaly

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