Tension hydrocele as an additional cause of acute scrotum: case series and literature review
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SPECIAL SECTION: MALE PELVIS
Tension hydrocele as an additional cause of acute scrotum: case series and literature review Jeries P. Zawaideh1 · Michele Bertolotto2 · Massimo Giannoni3 · Giovanni Piaggio4 · Felice Durand5 · Lorenzo E. Derchi6
© Springer Science+Business Media, LLC, part of Springer Nature 2019
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
Introduction The word hydrocele defines an abnormal collection of fluid within the tunica vaginalis. * Jeries P. Zawaideh [email protected] 1
Department of Health Sciences (DISSAL), Radiology Section, University of Genoa, C.so Montegrappa 26, Genoa, Italy
2
Department of Radiology, University of Trieste, Trieste, Italy
3
Emergency Radiology, Policlinico San Martino Hospital, Largo R. Benzi, 10, 16132 Genoa, Italy
4
University of Genoa, Genoa, Italy
5
Department of Urology, Policlinico San Martino Hospital, Largo Rosanna Benzi 10, 16130 Genoa, Italy
6
Department of Health Sciences (DISSAL), University of Genoa, Emergency Radiology, Policlinico San Martino Hospital, Largo R. Benzi, 10, 16132 Genoa, Italy
A small quantity of fluid at this level, however, is a physiological finding [1], and both fluid collections above 4 ml [2] or a ratio between the volume of the testes and the volume of the scrotum below 0.55 have been proposed to differentiate bet
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