Scrotal Hematoma Precipitated by Centrifuge Training in a Fighter Pilot with an Asymptomatic Varicocele

Kampel, Liyona; Klang, Eyal; Winkler, Harry; Gordon, Barak; Frenkel-Nir, Yael; Shoam, Yifat Erlich

doi:10.3357/amhp.4338.2015

Cited by 4 publications

(4 citation statements)

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“…Existing literature describes various activities preceding a spontaneous scrotal hematoma, reviewed in Table 1. Examples are pressure during defecation [4, 7, 9, 11], sexual intercourse [13], blunt abdominal trauma [5, 8, 14], heavy lifting [6], stretching in tight pants [15] or after fighter-pilot centrifuge training [19]. Another patient had a spontaneous hematoma after playing the saxophone [10].…”

Section: Discussionmentioning

confidence: 99%

Sneeze and pop: a ruptured varicocele; analysis of literature, guided by a well-documented case-report

et al. 2019

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BackgroundAn acute scrotal hematoma, secondary to a spontaneous rupture of a varicocele is still a rare presentation in daily practice. However, multiple case reports have been reported. Sudden increase in abdominal pressure, resulting to an increased venous pressure can lead to a rupture of the varicocele. Literature search shows that due to uncertainty of the diagnosis, explorative surgery is often performed, sometimes resulting in unnecessary orchiectomies. The objective of this study was to determine classical clinical presentation of patients with a spontaneous rupture of a varicocele, determine the diagnostic procedure, and give an insight in the follow-up.Case presentationWe present a case of a 24-year old male with acute scrotal swelling after sneezing. Subsequently, we carried out a systematic literature search to identify all eligible studies to determine classic clinical presentation of spontaneous ruptures of a varicocele.ConclusionThe literature search shows that clinical presentation of idiopathic spontaneous scrotal hematomas is similar to testicular torsion, epididymo-orchitis, malignancy, or (incarcerated) inguinal hernia making differential diagnosis difficult. Especially when there has been increased abdominal pressure or strenuous activity preceding the symptoms, and the swelling is left sided, it should be included in the differential diagnosis for patient with acute inguinoscrotal swelling. Colour Doppler-Ultrasonography is recommended to distinguish between other causes of acute scrotum. The hematoma is usual self-limiting, justifying conservative treatment. Early surgical intervention is indicated with signs of ischaemia due to obstruction, infection of the hematoma, or uncertain diagnosis (i.e. malignancy). However, physicians should be cautious with direct exploration, as it led to unnecessary orchiectomy in 25% of patients. The hematoma can increase in size up to 3 months post-event, and it can take up to 15 months to completely resolve.

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Section: Discussionmentioning

confidence: 99%

Sneeze and pop: a ruptured varicocele; analysis of literature, guided by a well-documented case-report

et al. 2019

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“…In the cases reported, as in our own experience, there was a noticeable enlargement of the hemiscrotum extending to the inguinal canal. In most cases there was a thickened spermatic cord and a palpable scrotal mass, but the consistency of the mass differed from fluctuant to firm [20, 24]. The testicle and the epididymis were normal on palpation in all cases.…”

Section: Discussionmentioning

confidence: 99%

“…In most cases reported to date, imaging techniques were used to identify and to differentiate the cause of the acute scrotum. The Doppler ultrasonography was the most frequently used technique, although some physicians used abdominopelvic CT study [16, 24] and some used a combination of both [21]. In all cases the imaging techniques successfully detected the presence of the hematoma and the source of the bleeding in some cases [24, 26].…”

Section: Discussionmentioning

confidence: 99%

“…Both patients were treated with NSAIDs, empiric antibiotics, bed rest, and ice packs, during and after hospitalization. The treatment strategies in the reported cases in literature were conservative when the clinical and imaging findings suggested scrotal hematoma [21, 24, 26], followed by uneventful recovery. In one case conservative treatment was unsuccessful and a scrotal exploration was performed five days later [23].…”

Section: Discussionmentioning

confidence: 99%

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Two Case Reports of Varicocele Rupture during Sexual Intercourse and Review of the Literature

Arif

Kotoulas

Georgellis

et al. 2018

Case Reports in Urology

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Varicocele is characterized by the dilatation of the veins of the spermatic cord. Its prevalence in general male population is 15% while in the infertile population the prevalence rises up to 25%. The varicocele is considered an etiological factor for male infertility. Although different pathophysiological patterns have been proposed, there is no consensus in the urological society to date. In most of the cases varicocele is asymptomatic but sometimes gives mild symptoms as dull pain at the scrotal region. A rare complication of this condition is the spontaneous or traumatic rupture and hematoma formation, either as spermatic cord hematoma or as scrotal hematoma. We are presenting two cases of varicocele rupture, presented with acute painful swelling of the left inguinal and scrotal region during sexual intercourse. Imaging studies revealed a scrotal hematoma in the first case and a spermatic cord hematoma in the second case, without signs of active bleeding. Both patients were treated conservatively and recovered uneventfully. Subsequently, we reviewed the literature in an effort to find the key points for the diagnosis and treatment of this condition.

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A Case of Posterior Nutcracker Syndrome Revealed in the Aerospace Environment

Chung¹,

Lytle²,

Fuentes³

2021

aerosp med hum perform

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BACKGROUND: Nutcracker syndrome is caused by a rare anatomic variant where the left renal vein is trapped between the aorta and the superior mesenteric artery. Posterior nutcracker syndrome is an even rarer entity, characterized by the retro-aortic positioning of the renal vein, causing compression between the aorta and spinal vertebrae. Symptoms include microscopic or frank hematuria, flank pain, varicocele, pelvic congestion syndrome, and abdominal pain. A search of the literature did not reveal prior cases of nutcracker syndrome that became symptomatic and diagnosed secondary to the unique stressors of high gravitational force (G force) in the aviation environment.CASE REPORT: A 25-yr-old man training as an F-16 flight test engineer presented with left scrotal/testicular pain, varicocele, and intermittent gross hematuria. After an extensive workup, he was diagnosed with posterior nutcracker syndrome and underwent a left varicocele ligation with spermatic cord denervation. He was eventually able to be returned to flying duties with limitation to non-high performance aircraft.DISCUSSION: This case is particularly unique as its diagnosis was dependent on exposure to high G force conditions that may have otherwise remained asymptomatic without this environmental stressor. Education on the diagnosis of nutcracker syndrome as a differential in the setting of hematuria and pain is an important lesson learned. This case also illustrates the necessity of considering the effects of the stressful environment of high G force on even overall healthy individuals. Fortunately, due to the collaboration of medical-surgical expertise and familiarity with the requirements for operational readiness, this patient was able to resume his aviation career, albeit in a different capacity compatible with his condition.Chung CY, Lytle ME, Clemente Fuentes RW. A case of posterior nutcracker syndrome revealed in the aerospace environment. Aerosp Med Hum Perform. 2021; 92(1):5456.

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Scrotal Hematoma Precipitated by Centrifuge Training in a Fighter Pilot with an Asymptomatic Varicocele

Cited by 4 publications

References 0 publications

Sneeze and pop: a ruptured varicocele; analysis of literature, guided by a well-documented case-report

Sneeze and pop: a ruptured varicocele; analysis of literature, guided by a well-documented case-report

Two Case Reports of Varicocele Rupture during Sexual Intercourse and Review of the Literature

A Case of Posterior Nutcracker Syndrome Revealed in the Aerospace Environment

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