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Sonographic findings in clinically unsuspected acute and chronic scrotal hematoceles
Insights
A hematocele, a collection of blood in the scrotum, can appear as a multicystic mass on ultrasound. This diagnosis should be considered even with atypical patient history and physical findings.
Area of Science:
- Radiology
- Urology
- Pathology
Background:
- Scrotal swelling is a common clinical presentation with diverse etiologies.
- Atypical clinical presentations can complicate the diagnosis of scrotal pathologies.
- Distinguishing between neoplastic and non-neoplastic scrotal masses is crucial for appropriate management.
Observation:
- Three patients presented with scrotal swelling of varying durations (2 days to many years).
- Clinical history and physical examinations were atypical for the eventual diagnosis.
- Contact B-scan ultrasound revealed a predominantly anechoic mass with thick, irregular septations in all cases.
Findings:
- The sonographic appearance of a multicystic mass was consistent across all patients.
- In one acute case, the septations showed a decrease in size and number over a 10-day period.
- The final diagnosis for all three patients was hematocele.
Implications:
- Hematocele should be included in the differential diagnosis of scrotal swelling presenting as a multicystic mass on ultrasound.
- Sonographic findings of a multicystic mass warrant consideration of hematocele, irrespective of atypical clinical features.
- This highlights the importance of integrating imaging findings with clinical context in scrotal pathology diagnosis.
Abstract:
Three patients with scrotal swelling for 2 days, a year, and many years, respectively, were shown ultimately to have hematoceles even though their clinical history and physical findings were atypical. Contact B-scans of these lesions all showed a basically anechoic mass traversed by thick irregular septations. The septations in one acute case decreased in size and number over 10 days. Hematocele should be considered in the differential diagnosis when sonographic ultrasound studies of a scrotal swelling reveal a multicystic mass even if the history and physical findings are more compatible with neoplasm.