Spontaneous, atraumatic hydrocele rupture: A case report.

There is little information in the literature on the management and prognosis of ruptured hydroceles. We present a case report of spontaneous, atraumatic left hydrocele rupture in a 64-year-old male. His hydrocele was initially diagnosed as non-complex and appeared to have ruptured spontaneously three years after initial onset. On follow-up in clinic, mild re-accumulation of fluid was observed, and no pain was reported by the patient. Post-rupture fluid re-accumulation was minimal in our patient but there is potential for significant fluid re-accumulation based on other reports of ruptured hydroceles.

Post COVID-19 pneumo-hematocele: clinical presentation and treatment pathway.

OBJECTIVES: The appearance of characteristic pulmonary lesions has been noted after COVID-19, being described as post-COVID-19 pneumo-hematocele. The aim of this study is to describe the clinical, histopathologic, and imaging features of pneumo-hematocele and to suggest a treatment algorithm for these patients. METHODS: A retrospective study was performed in patients admitted with a diagnosis of SARS-CoV2 infection from March 2020 to September 2021 who presented a pneumo-hematocele on imaging studies. Clinical and demographic variables were recorded, and CT scans were analyzed. A secondary analysis was performed to estimate the risk provided by the pneumo-hematocele diameter of developing pneumothorax. RESULTS: 37 patients were diagnosed with pneumo-hematoceles, 97.3% were males with a median age of 41 ± 13 years and 51% were smokers. The mean diameter of the pneumatocele was 6.3 ± 2.8 cm; they were more common on the subpleural surface and in the inferior lobe. Thirty patients had ruptured pneumo-hematoceles and developed pneumothorax (81.1%); a total of 26 patients required surgery (70.3%). Lesions measuring 5 cm had a high risk of rupture (OR 6.8, CI 95% 1.1-42); those measuring 3 cm were prone to this complication. For each centimeter that the pneumo-hematocele diameter increases, the OR for rupture increases 1.5. CONCLUSIONS: It appears that post-COVID-19 pneumo-hematocele occurs secondary to encapsulation of blood accumulation inside the lung, as a result of micro-capillary bleeding, with partial reabsorption of blood and subsequent air filling. We recommend surgery for patients with pneumo-hematoceles of 5 cm and those with persistent lesions of 3 cm. TRIAL REGISTRATION: Clinical Trial Registration: NCT05067881.

Hematocele y hemoperitoneo como manifestación inicial de carcinoma hepatocelular: caso clínico / Hematocele and hemoperitoneum as initial manifestation of hepatocellular carcinoma: report of one case

Hepatocellular carcinoma (HCC) rupture is a rare complication, with a higher prevalence in countries of Asia and Europe. Its clinical manifestations can be nonspecific, from abdominal pain and bloating to hemodynamic involvement. We report a 70-year-old male patient with a history of chronic liver disease, presenting with an enlargement and ecchymosis of the scrotum, associated with abdominal bloating. The initial abdominal ultrasound study showed increased liquid content in the scrotal sac and regional edema. A CT of the abdomen and pelvis showed a liver mass with characteristics of hepatocellular carcinoma, associated with extensive hemoperitoneum that drained into the scrotal sac. The patient was treated with embolization of the right hepatic artery and later with surgical resection of the tumor mass, with a good clinical evolution.

Non-surgical treatment for hematocele in the bladder associated with ascites puncture in a patient with ovarian hyperstimulation syndrome: a case report.

Ovarian hyperstimulation syndrome (OHSS) is a well-known complication induced by the application of LH or GnRH analogs in the process of assisted reproduction controlled ovarian stimulation (COS). Ascites puncture is one of the treatments for severe OHSS. In the vast majority of circumstances, transvaginal (TV) ascites puncture under B ultrasound guidance is safe; however, bladder injury is a rare complication that may occur during the puncture process. We presented the case of a 28-year-old woman who presented with hematuria and dysuria following TV puncture for ascites aspiration for OHSS. Ultrasonographic examination revealed a 8.33 × 4.88 cm hematocele in the bladder; it was thought to have been caused by blood clot formation and concurrent urinary retention resulting from the puncture needle-induced bladder injury during TV puncture for ascites aspiration. The patient recovered with conservative treatment. Therefore, it is important to emphasize that avoidance of OHSS is necessary to avoid complications such as bladder damage from treatment of ascites.

A case of a hematocele of the spermatic cord mimicking epididymal tumor.

A 68-year-old man visited our hospital complaining of painless left scrotal swelling. Stony hard mass was palpable at cephalad side of the testis. MRI showed a solid component mass mimicking epididymal tumor. Thus, exploratory surgery was performed. Since the tumor was firmly adhesive to the spermatic cord, an orchiectomy was unavoidable. The pathological result was hematocele of the spermatic cord.

Orbital cholesterol granuloma: A report and discussion of orbital findings.

PURPOSE: To report a case of orbital cholesterol granuloma and discuss the orbital findings seen in this entity. OBSERVATION: A 38-year-old male presented with an 8-month history of progressive left upper lid ptosis and hypoglobus. Clinical examination was significant for 3 mm of hypoglobus and restricted supraduction in the left eye. Contrasted computed tomography imaging revealed a well-circumscribed lesion in the superotemporal orbit causing extensive bone erosion that appeared to arise from the lacrimal gland. An incisional biopsy was performed, and histopathological evaluation demonstrated fibrovascular tissue surrounding a mixture of histiocytes and cholesterol clefts, consistent with a cholesterol granuloma. CONCLUSIONS AND IMPORTANCE: Orbital cholesterol granulomas are rare lesions that are predominantly found in the superotemporal orbit. These lesions can be associated with marked bony changes in the superotemporal fossa that can be mistaken for a lacrimal gland neoplasm; however, bony erosion is a hallmark of this lesion and should be considered on the differential diagnosis of any lacrimal gland mass with extensive bony erosion.

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

BACKGROUND: An 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 PRESENTATION: We 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. CONCLUSION: The 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.

[Therapeutic management of blunt testicular trauma]. / Therapiemanagement des stumpfen Hodentraumas.

Testicular trauma is a rare emergency. While penetrating injuries need surgical revision, blunt injuries may be treated conservatively. However, in case of testicular rupture early surgical intervention increases the chance of testicular preservation. Therefore, a meticulous urological diagnosis is important to avoid complications and to reduce rates of secondary orchiectomy.

Perspectives in Pediatric Pathology, Chapter 23. Testicular Pathology Secondary to Physical and Chemical Injury.

Testicles can be damaged by a variety of physical and chemical agents, ranging from trauma suffered in accidents or athletic activities, to diverse drugs or radiation used in cancer treatment. The immediate and long-term effects of these damaging agents at the testicular morphologic and functional levels are quite varied and may have significant impact on the fertility of the pediatric patient once reproductive age is reached.

Surgically Confirmed Intra- and Extratesticular Hematoma Clinically Mimicing Epididymo-Orchitis and Radiologically Mimicing Traumatic Torsion.

BACKGROUND: Scrotal blunt trauma may result in injuries, such as testicular rupture, dislocation, torsion, hematoma, spermatic cord injury or contusion, and epididymal, scrotal, and urethral injuries. Ultrasonography (US) has a crucial role in the evaluation of those kinds of pathologies. Early diagnosis of testicular rupture may lead to the salvaging of the testicle by prompt surgical exploration within 72 h. CASE REPORT: A 21-year-old male with right scrotal swelling and pain complaints was admitted to another hospital one month ago. Epididymo-orchitis was diagnosed and the patient was given medical treatment. The patient was admitted to our emergency service with ongoing complaints. The patient stated that the pain and swelling suddenly developed after prolonged marching. On US, a large hematoma was detected between the leaves of the tunica vaginalis, and rupture from the lower pole was diagnosed. On color Doppler US, no vascularity was observed in the heterogeneous testicular parenchyma. Traumatic torsion was primarily suggested. Intraoperatively, an extratesticular hematoma, hematocele, and rupture were confirmed but torsion was not found. Because the hematoma entirely replaced the normal parenchyma, orchiectomy was performed. CONCLUSIONS: Testicular rupture may occur even after moderate sportive action such as prolonged marching. If any delay occurs in diagnosis and/or operation, the coagulum may replace the entire parenchyma. We think that US and clinical findings may sometimes mislead the physicians and cause misdiagnoses, such as inflammation or torsion. In this paper, we present a complex delayed diagnosed example case of testicular rupture clinically mimicing epididymo-orchitis and radiologically mimicing traumatic testicular torsion.

Hemorragia suprarrenal que se manifiesta como hematoma escrotal en el recién nacido: A propósito de un caso / Adrenal hemorrhage presenting as a scrotal hematoma in the newborn: A case report

La hemorragia suprarrenal neonatal es poco frecuente. Se presenta en el 0,2% de los recién nacidos. El 10% de los casos son bilaterales. Puede estar asociada a un traumatismo al nacimiento, peso alto al nacer o un curso neonatal complicado por hipoxia, asfixia, hipotensión o coagulopatía. El hematoma escrotal es una manifestación extremadamente rara de la hemorragia suprarrenal neonatal. La mayoría de los pacientes presentan tumefacción escrotal con coloración azulada. En los recién nacidos, la tumefacción escrotal, con o sin coloración azulada, puede deberse a diferentes causas. Comunicamos un caso inusual de hemorragia suprarrenal neonatal secundaria a asfixia perinatal, que se manifestó con un hematoma escrotal. El diagnóstico de hemorragia suprarrenal neonatal y hematoma escrotal fue ecográfico; el tratamiento conservador evitó la exploración quirúrgica innecesaria.(AU)

Neonatal adrenal hemorrhage is uncommon. It is present in 0,2% of newborns. Ten percent of the cases occur bilaterally. It can be associated with birth trauma, large birth weight, or neonatal course complicated by hypoxia and asphyxia, hypotension, or coagulopathy. Scrotal hematoma is an extremely rare manifestation of NAH. Most patients present scrotal swelling with bluish discolouration. Scrotal swelling with/without bluish discoloration in newborns may result from different causes. We report an unusual case of neonatal adrenal hemorrage secondary to perinatal asphyxia, associated with SH. Neonatal adrenal hemorrhage and scrotal hematoma were diagnosedby ultrasonography and treated by conservative treatment, avoiding unnecessary surgical exploration.(AU)

Hemorragia suprarrenal que se manifiesta como hematoma escrotal en el recién nacido: A propósito de un caso / Adrenal hemorrhage presenting as a scrotal hematoma in the newborn: A case report

La hemorragia suprarrenal neonatal es poco frecuente. Se presenta en el 0,2% de los recién nacidos. El 10% de los casos son bilaterales. Puede estar asociada a un traumatismo al nacimiento, peso alto al nacer o un curso neonatal complicado por hipoxia, asfixia, hipotensión o coagulopatía. El hematoma escrotal es una manifestación extremadamente rara de la hemorragia suprarrenal neonatal. La mayoría de los pacientes presentan tumefacción escrotal con coloración azulada. En los recién nacidos, la tumefacción escrotal, con o sin coloración azulada, puede deberse a diferentes causas. Comunicamos un caso inusual de hemorragia suprarrenal neonatal secundaria a asfixia perinatal, que se manifestó con un hematoma escrotal. El diagnóstico de hemorragia suprarrenal neonatal y hematoma escrotal fue ecográfico; el tratamiento conservador evitó la exploración quirúrgica innecesaria.

Neonatal adrenal hemorrhage is uncommon. It is present in 0,2% of newborns. Ten percent of the cases occur bilaterally. It can be associated with birth trauma, large birth weight, or neonatal course complicated by hypoxia and asphyxia, hypotension, or coagulopathy. Scrotal hematoma is an extremely rare manifestation of NAH. Most patients present scrotal swelling with bluish discolouration. Scrotal swelling with/without bluish discoloration in newborns may result from different causes. We report an unusual case of neonatal adrenal hemorrage secondary to perinatal asphyxia, associated with SH. Neonatal adrenal hemorrhage and scrotal hematoma were diagnosedby ultrasonography and treated by conservative treatment, avoiding unnecessary surgical exploration.

Scrotal collections: pictorial essay correlating sonographic with magnetic resonance imaging findings / Coleções na bolsa testicular: ensaio iconográfico correlacionando achados ultrassonográficos com a ressonância magnética

The present study is aimed at describing scrotal collections observed at ultrasonography and magnetic resonance imaging. The authors describe the main features of hydrocele, hematocele and pyocele, as well as the most common causes, clinical manifestations and associated diseases, with a brief review of the embryology and anatomy of the scrotum. Collections are frequently found in the evaluation of the scrotum, which is often performed on an emergency basis, and in most cases can be differentiated by means of imaging studies. With the consolidation of magnetic resonance imaging as the method of choice complementary with ultrasonography, the authors also describe magnetic resonance imaging findings of scrotal collections as well as the situations where such method is indicated.

O objetivo deste trabalho é descrever coleções na bolsa testicular vistas na ultrassonografia e na ressonância magnética. São descritas as principais características da hidrocele, hematocele e piocele, assim como as causas mais comuns, manifestações clínicas e doenças associadas, com uma breve revisão da embriologia e anatomia da bolsa testicular. Coleções são achados frequentes na avaliação da bolsa testicular, muitas vezes realizada em caráter de urgência, e podem ser diferenciadas por meio de exames de imagem. Com a consolidação da ressonância magnética como exame de escolha em complemento à ultrassonografia, são também descritas as características das coleções escrotais na ressonância magnética, além das indicações para a sua realização.

Scrotal hematoma as a sign of adrenal hemorrhage in newborns / Hematoma escrotal como um sinal de hemorragia da adrenal no recém-nascido

CONTEXT: Bluish discoloration and swelling of the scrotum in newborns can arise from a number of diseases, including torsion of the testes, orchitis, scrotal or testicular edema, hydrocele, inguinal hernia, meconium peritonitis, hematocele, testicular tumor and traumatic hematoma. Forty-two cases of scrotal abnormalities as signs of neonatal adrenal hemorrhage were found in the literature. CASE REPORT: We present a case of scrotal hematoma due to adrenal hemorrhage in a newborn. Conservative treatment with clinical follow-up was adopted, with complete resolution within 10 days. The possible differential diagnoses are reviewed and discussed.

CONTEXTO: Edema e coloração azulada do escroto do recém-nascido podem sugerir uma série de doenças, incluindo torção dos testículos, orquite, edema escrotal e testicular, hidrocele, hérnia inguinal, peritonite meconial, hematocele, tumor testicular e hematoma traumático. Quarenta e dois casos de alterações escrotais como sinal de hemorragia da glândula adrenal foram encontrados na literatura. RELATO DE CASO: Apresentamos um caso de hematoma escrotal devido a hemorragia da glândula adrenal em um recém-nascido. O tratamento adotado foi conservador, com acompanhamento clínico, com resolução completa em 10 dias. Os possíveis diagnósticos diferenciais são revisados e discutidos.