Hematocele

Hematocele
A massive hemoscrotum (scrotal hematoma) which occurred as a complication of inguinal hernia repair. The scrotum was explored surgically, and a drain was left behind (seen on the right thigh). A Foley catheter is in place to prevent urinary retention.
Specialty	Urology

A hematocele is a collections of

A scrotal hematocele is also called a hemoscrotum (or haemoscrotum in British English). Scrotal masses are abnormalities in the bag of skin hanging behind the penis (scrotum).^[7] The scrotum contains the testicles and related structures that produce, store and transport sperm and male sex hormones.^[7]

Hemoscrotum can follow

Variation in signs and symptoms will depend on the abnormality present and medical history.[8]^[7] Variation exists in hematoceles due to the location of the lesion and onset of the hematocele.^[9] It is important to seek emergency medical care if developing sudden pain in the scrotum to avoid damage to the testicle that can be permanent.^[7] The signs and symptoms listed below are relating to hematoceles and associated conditions that can be due to other causes such as testicular cancer or testicular torsion:^[7]

• Unusual lump
• Sudden pain
• Dull aching pain or feeling heavy in the scrotum
• Pain radiating throughout the groin, abdomen, or lower back
• Tender, swollen, or hardened testicle
• Tender, swollen, or hardened epididymis, the soft, comma-shaped tube above and behind the testicle that stores and transports sperm
• Swelling in the scrotum
• Redness of the skin of the scrotum
• Nausea or vomiting

If the cause of the scrotal mass is due to infection then signs and symptoms may be the following:^[7]

• Pus
• Pus or blood in the urine
• Fever

Cause

Scrotal masses might be an accumulation of fluids, the growth of abnormal tissue, or normal contents of the scrotum that have become swollen, inflamed or hardened.^[7] Scrotal masses could be cancerous or caused by another condition that affects testicular function and health.^[7] A hematocele is one of the most common sequelae of testicular trauma.^[8] A traumatic hematocele usually results from testicular rupture (80% of cases) or a tear in the pampiniform plexus veins.^[8] Testicular rupture and testicular torsion are also common causes of scrotal hematocele.^[8] It can also be caused by kidney injury, pancreatitis, hematological dysfunction, or vasculitis.^[8]

There are different disorders that can result as a consequence or a hematocele which include:^[7]

• Testicular cancer
• Spermatocele
• Epididymitis
• Orchitis
• Hydrocele
• Variocele
• Inguinal hernia
• Testicular torsion

Pathophysiology

Chronic hematocele is rare. The direct cause of hematoceles is still unknown.^[10] Hematoceles can be classified into idiopathic and secondary ones.^[10] Idiopathic or spontaneous hematoceles give no history of testicular cancer or past trauma to testis, no pain in the organ, and seems to be more common the older population.^[10] Secondary hematoceles are usually associated with trauma, surgery, or neoplasm, but can also be caused by hematological alterations, or vasculitis.^[8]

Presumably minor trauma results in rupture of dilated

Hematoceles can be a challenge to diagnose since they can mimic cysts or neoplasms.[10] There can different exams used in combination to make a final diagnosis:^[10]

• Physical exam
• Ultrasound
• Urine test
• Blood test
• CT scan
• MRI scan

Differential diagnosis of hematocele includes testicular tumor, testicular torsion, and

Most hematoceles will require minor or more serious medical procedures depending on the severity. The repair of a hematocele rupture may be difficult, especially if it is circumferential. This is because in such cases a large portion of parenchyma is herniated and may already be necrotic.^[8]

If the hematocele is relatively small and does not cause a lot of pain, conservative treatment such as foot elevation and bed rest may be sufficient.^[11] In more severe cases, surgical intervention may become necessary.^[11] Surgery may be performed to drain the accumulated blood from the scrotum.^[11] If a testicular tumor is found to be the cause of the bleeding, the entire testicle is generally removed to prevent cancer from spreading to other parts of the body.^[11] If surgery becomes necessary to treat the hematocele, it may take several weeks for the patient to recover fully from the procedure.^[11] This is due to the fact that the scrotum tends to swell after the surgery.^[11] This swelling can cause discomfort or pain that does not easily go away.^[11] Prescription medications are often given to help the patient recover from the surgery.^[11]

Regular medical checkups can help a doctor to look out for any type of hematocele.^[11] Early detection is the key in treating most medical conditions.^[11] With different types of hematoceles, complications can develop very quickly so it is particularly important to receive an early diagnosis.^[11] In order to prevent hematoceles, it is important to have testicular self-exams to help find abnormalities sooner.^[11] Doing this can help to understand what is normal in the body and be able to detect abnormalities in the body.^[11] This can include examining testicles once a month, especially if the person has had previous testicular cancer or a history of testicular cancer.^[7]

Prognosis

The life expectancy of all individuals with hematoceles will depend on the severity and the underlying causes that could have led to hematoceles.^[8] Not all hematoceles will result in long term complications.^[11] However they can affect the health or function of the testicle that can lead to:^[7]

• Delayed or poor development if at a young age
• Infertility

The hematocele severity will depend on whether it is symptomatic or asymptomatic.^[11] If surgically removed, the recovery can take weeks, causing such a procedure to be performed only in extreme cases.^[11]

Epidemiology

Hematoceles should be cleared quickly to avoid pressure of the atrophy of the parenchyma.^[8] Rare complication can results such as infection, suppupation, and scrotal gangrene.^[8]

Research Directions

Hematoceles are rare, making them harder to diagnose and treat.^{[citation needed]}

Another case study presents an 18 male that presented with huge painless right sided scrotal mass which was gradually increasing in size and associated with dragging sensation.^[12] The case study presents the patient with no history of any trauma or previous surgery, and general physical condition being normal.^[12] On examination, right testis was enlarged, hard and non tender with loss of testicular sensation.^[12] The pathological diagnosis was consistent with chronic hematocele.^[12]

Current research is ongoing for proper diagnosis and helping to differentiate among other conditions. Doppler ultrasound in a

Scrotal masses are a common presentation in primary care, and a painful scrotum accounts for 1% of emergency department visits.[14] As of 2017, there has only been 35 cases reported so far in the known world literature, few scattered case reports published in medical journals of different languages.^{[citation needed]}

References