Idiopathic chronic hematocele of the vaginal sac

Abstract

We report a 39-year-old male who presented non-traumatic testicular swelling and pain. Physical examination and sonography presented a suspicion of testicular tumor and both surgical exploration and inguinal orchiectomy were performed. Hematocele may both clinically and sonographically resemble a testicular tumor. The diagnostic study of choice is magnetic resonance, establishing the diagnosis and differentiating it from neoplasms.

The Strange Case of a Haematocele Mistaken for a Neoplastic Scrotal Mass

“…That is the case of the hematocele, which results from the accumulation of blood within the vaginal sac, usually as a consequence of trauma. 2,4 Very rarely, hematoceles originate from idiopathic or spontaneous bleeding, especially in elderly patients. 1 Blood slowly accumulates in the vaginal sac, with a progressive, painless scrotal swelling.…”

“…In our case, where the ultrasound was inaccurate, the MRI was useful in the diagnosis. 4 However, even an MRI can lead to false conclusions. Given the MRI images, we suspected a neoplasia originating from the tunica vaginalis, which prompted the execution of a radical orchifunicolectomy.…”

“…This managements avoids testicular compression and prevents epididymo-orchitis abscess formation and necrosis, as unresorbed hematocele can eventually become infected. 2,4 When the presence of cancer is strongly suspected, a more radical approach with an inguinal incision is advisable. We decided not to perform intraoperative frozen-section examination as the testis did not appear to be viable, and the necrotic-hemorragic appearance of the mass strongly indicated cancer.…”

“…In the literature, only a few cases of idiopathic, chronic haematoceles are reported. 1,[4][5][6]8 Orchifunicolectomy was performed almost invariably, as testicular cancer was impossible to rule out with certainty.…”

Chronic Scrotal Hematocele: A Rare Entity and Diagnostic Dilemma

“…Cunningham (1983) finds septation is a consistent findings in both acute and chronic hematoceles, 10 magnetic resonance imaging (MRI) is more specific but not diagnostic and when MRI performed for chronic hematocele itreveal encapsulated mass with high signal intensity in both T1 and T2 images. 3,11,12…”