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Case Reports
. 2022 Aug 30;10(6):101012.
doi: 10.1016/j.jvscit.2022.08.017. eCollection 2024 Dec.

Undiagnosed scrotal swelling in a 36-year-old man: A congenital arteriovenous malformation

Frank A Cusimano  1   2 , Adriana Vaglica  3 , Christine Mitchell  3 , Martyna Czarnik  2 , Adam Tonis  3 , David A Greuner  3
Affiliations
Case Reports

Undiagnosed scrotal swelling in a 36-year-old man: A congenital arteriovenous malformation

Frank A Cusimano et al. J Vasc Surg Cases Innov Tech. .

Abstract

We have reported the case of a 36-year-old man with severe scrotal swelling that had remained undiagnosed after multiple diagnostic tests. The patient had presented with scrotal swelling, multiple weeping ulcers on the dorsal aspect of the scrotum, and worsening pain affecting his day-to-day functioning. Duplex ultrasound showed low- to no-flow hypervascularity and dependent edema suspicious for a vascular malformation. Treatment included sequential Gelfoam (Pfizer, New York, NY) embolization using ultrasound-guided direct cannulation and traditional angiography. The scrotal circumference decreased by 65%, with moderate relief of his pain. The details from the present case have highlighted the significance of vascular malformations, various diagnostic and therapeutic techniques used, and value of endovascular embolization.

Keywords: Arterial malformations; Arteriovenous malformations; Lymphedema; Malformations; Scrotal swelling; Venous malformations.

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Figures

Fig 1
Fig 1
Images before and after treatment. Left, Photograph before treatment showing scrotum measuring 30 cm in diameter with significant swelling and edema. Middle, Photograph immediately after final embolization. Right, Photograph at postoperative follow-up examination after embolization showing a 65% reduction in size, with the scrotum measuring 10.5 cm in diameter.
Fig 2
Fig 2
Duplex ultrasound and low-flow vascularity. Left, Duplex ultrasound scan of left testis and spermatic cord showing multiple vessels with areas with a biphasic mosaic pattern representing turbulent flow suspicious for vascular malformations. Right, Fluoroscopic-guided direct cannulation of the scrotum.
Fig 3
Fig 3
Diagram showing arterial blood supply of male penis and scrotum but not the arteriovenous malformations (AVMs) identified or blood supply to the testes via the testicular artery.
Fig 4
Fig 4
Top left, Angiogram of anterior scrotal artery off external pudendal artery. Top right, Angiogram of external pudendal artery after embolization of vascular malformations off anterior scrotal artery. Bottom left, Angiogram of arterial malformations off internal pudendal artery. Bottom right, Angiogram of internal pudendal artery after embolization of malformations off posterior scrotal artery, artery of bulb, and perineal artery.
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