Jeries P Zawaideh1, Michele Bertolotto2, Massimo Giannoni3, Giovanni Piaggio4, Felice Durand5, Lorenzo E Derchi6. 1. Department of Health Sciences (DISSAL), Radiology Section, University of Genoa, C.so Montegrappa 26, Genoa, Italy. jeriespz89@gmail.com. 2. Department of Radiology, University of Trieste, Trieste, Italy. 3. Emergency Radiology, Policlinico San Martino Hospital, Largo R. Benzi, 10, 16132, Genoa, Italy. 4. University of Genoa, Genoa, Italy. 5. Department of Urology, Policlinico San Martino Hospital, Largo Rosanna Benzi 10, 16130, Genoa, Italy. 6. Department of Health Sciences (DISSAL), University of Genoa, Emergency Radiology, Policlinico San Martino Hospital, Largo R. Benzi, 10, 16132, Genoa, Italy.
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.
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.
Authors: Michele Bertolotto; Simon Freeman; Jonathan Richenberg; Jane Belfield; Vikram Dogra; Dean Y Huang; Francesco Lotti; Karolina Markiet; Olivera Nikolic; Subramaniyan Ramanathan; Parvati Ramchandani; Laurence Rocher; Mustafa Secil; Paul S Sidhu; Katarzyna Skrobisz; Michal Studniarek; Athina Tsili; Ahmet Tuncay Turgut; Pietro Pavlica; Lorenzo E Derchi Journal: J Ultrasound Date: 2020-07-27