Hemorrhagic epididymal cyst mimicking testicular torsion: A case report

Testicular torsion is a surgical emergency requiring rapid diagnosis and treatment to prevent testicular loss. However, other conditions, such as hemorrhagic epididymal cyst rupture, can mimic its presentation, posing diagnostic challenges.

A 25-year-old male presented with sudden, severe right scrotal pain. Examination revealed a tender superior epididymal mass. Scrotal ultrasound showed homogeneous fluid collection with normal testicular blood flow. Due to severe pain, surgical exploration ruled out torsion and confirmed a hemorrhagic epididymal cyst, which was excised intact.

Distinguishing testicular torsion from hemorrhagic epididymal cyst rupture is crucial. Doppler ultrasound remains the primary diagnostic tool, with torsion showing absent blood flow, whereas cysts maintain normal or increased vascularization. In unclear cases, surgical exploration is justified to prevent testicular loss.

Although testicular torsion is the most critical cause of acute scrotal pain, alternative diagnoses, such as hemorrhagic epididymal cyst rupture, should be considered. Prompt diagnosis using clinical evaluation and imaging can prevent unnecessary orchiectomy, with surgical exploration remaining the safest option in uncertain cases.