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Case Reports
. 2014 Jul 21:79:219-21.
doi: 10.12659/PJR.890915. eCollection 2014.

Idiopathic scrotal hematoma simulating a testicular torsion, in association with cryptorchidism: US findings

Vincenzina Crisci  1 , Ciro Esposito  2 , Ida Giurin  2 , Valerio Vitale  1 , Gianfranco Vallone  3
Affiliations
Case Reports

Idiopathic scrotal hematoma simulating a testicular torsion, in association with cryptorchidism: US findings

Vincenzina Crisci et al. Pol J Radiol. .

Abstract

Background: An acute scrotum concerns endoscrotal organs (testicles, spermatic cord, tunica vaginalis) and is characterized by pain, swelling and hyperemia of the hemi-scrotum. It represents one of the most common surgical emergencies in children often caused by testicular torsion; the diagnosis is mostly clinical but must be supported by ultrasonographic examination of the scrotal region in association with a colour Doppler study of the spermatic cord vessels and glandular parenchyma. An idiopathic scrotal hematoma is a very rare condition that can simulate it.

Case report: A 3-day-old full-term baby, otherwise in good health, showed swelling and pain of the left inguinal-scrotal region. A testicular torsion was suspected, so the baby underwent an ultrasound examination of the testis and spermatic cord that showed a left scrotal hematoma with superior displacement of the didymus; the right testicle was located in the internal inguinal canal. Surgical intervention confirmed the sonographic diagnosis of left testicular hematoma and of the right cryptorchidism.

Conclusions: Although testicular torsion is the most frequent cause of acute scrotum, the possibility of a persistent idiopathic scrotal haematoma and/or haematoma secondary to a trauma of the inguino-scrotal region, must be always taken into account. US diagnosis can avoid unnecessary emergency surgical treatment, required in case of testicular torsion.

Keywords: Cryptorchidism; Spermatic Cord Torsion; Ultrasonography, Doppler, Color.

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Figures

Figure 1
Figure 1
Ultrasound image of the left hemi-scrotum showing an oval iso-hypoechoic formation with a maximum diameter of 20 mm.
Figure 2
Figure 2
Ultrasound image of the left part of the interior inguinal canal, showing an ipsilateral testicle displaced cranially (top left). The left hemi-scrotum appeared to be occupied by the hematoma (bottom right) showing peripheral vascular spots.
Figure 3
Figure 3
Surgical exploration of the left hemi-scrotum showing evidence of a large hematoma involving the peri-testicular tissues with didymus, and of the epididymis, which were normal in morphology, volume, consistency and vascularization.
See this image and copyright information in PMC

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