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

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.

Ultrasound evaluation of varicoceles: systematic literature review and rationale of the ESUR-SPIWG Guidelines and Recommendations

“…Patients presenting with uncommon conditions [ 170 , 171 ], as well as patients with extratesticular cavernous haemangiomas, lymphangiomas, and arteriovenous malformations can present with a non-specific diagnosis, or with suspicion of a varicocele based on their clinical presentation [ 172 – 174 ]. Although MRI is the modality of choice for delineating the extent of these abnormalities, in clinical practice, the diagnosis is usually obtained with US.…”

Case – Tension hydrocele: A rare cause of acute scrotal pain

“…Zawaideh et al speculate that the acute pain that accompanies such phenomena is a combination of the duration of the hydrocele and the acute change in intratesticular pressure, though the contribution of each factor is unknown. 8 To our knowledge, this is the first case report with radiographic evidence of previously normal testicular perfusion that became impaired with increased hydrocele size. We were also able to demonstrate resolution post-surgery.…”

Historical trends for the standards in scrotal ultrasonography: What was, what is and what will be normal

“…Figure 2F-H), 1,91,92 other pathological conditions resulting in testicular ischemia, such as tension idroceles, 93 as well as in the assessment of scrotal trauma, when considered along with other clinical and US features. 25 In the event of acute scrotal pain, a normal scrotal content and testis vascularity should prompt extension of the US investigation to the abdomen, to exclude non-scrotal causes of acute pain.…”