Hematocele of the spermatic cord – A case report

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Information about Hematocele of the spermatic cord – A case report

Published on September 30, 2015

Author: Apollo_Hospitals

Source: slideshare.net

1. Hematocele of the spermatic cord – A case report

2. Case Report Hematocele of the spermatic cord – A case report Gite Vandana *, Dhakane Maruti Apollo Hospitals, Bilaspur, India 1. Introduction Thecommonpathologicallesionsseeninthespermaticcordare torsion, varicocele, funiculocele, etc. Hydrocele of the testis and spermatic cord is a common disease with the highest incidence commonly encountered among patients with inguinal region swelling. Hematocele of the spermatic cord is seen rarely. Preoperative diagnosis is not common; it mimics a tumor and is usually present as operative or histological surprises. 2. Case report A 71-year-old, male patient, with a known case of diabetes, hypertension, and coronary artery disease (POST OP CABG) came with complaints of swelling present over left inguinal region since 7 days associated with pain. The patient had no history of fever, vomiting, or trauma. He is on regular medication of oral antidiabetic, angiotensin-converting- enzyme (ACE) inhibitor, angiotensin II receptor antagonists, beta-1 receptor antagonists, HMG CoA reductase inhibitors, and cyclooxygenase inhibitors. Radiological investigations showed fairly nodular lesion. Fine needle aspiration yielded blood with macrophages and few inflammatory cells. Then the patient underwent excision of lump with left sided orchidectomy. Gross examination revealed left orchidectomy specimen including testis (4 Â 2.5 Â 3 cm), epididymis (0.8 Â 2.5 Â 1 cm), and spermatic cord 12 cm in length. The spermatic cord shows cystic mass measuring 5.5 Â 3.5 Â 3 cm, covered by thick capsule, congested, and filled with blood clots (Fig. 1). Testis covered with tunica show smooth outer surface and unre- markable parenchyma. The epididymis was unremarkable. Histological examination shows that the wall of the cyst consisted of edematous connective tissue with congested dilated vessels, hemorrhage, and cellular infiltration (Fig. 2). 3. Discussion Among the diseases that cause painful swelling in the inguinal region, mention may be made of orchitis, torsion of the testis a p o l l o m e d i c i n e x x x ( 2 0 1 5 ) x x x – x x x * Corresponding author at: Associate Consultant, Department of Lab Services, Apollo Hospitals, Bilaspur CG, India. Tel.: +91 09755040727/09893542691. E-mail address: vandanagite@gmail.com (G. Vandana). a r t i c l e i n f o Article history: Received 15 July 2015 Accepted 24 August 2015 Available online xxx Keywords: Spermatic cord Hematocele Painful swelling a b s t r a c t Hematocele of the spermatic cord is seen rarely. Recently, we have encountered a case of a 71-year-old male, who suddenly had a painful swelling in the left inguinal region and it was diagnosed as hematocele of the spermatic cord. Preoperative diagnosis is not common; it mimics a tumor and is usually present as operative or histological surprises. # 2015 Indraprastha Medical Corporation Ltd. Published by Elsevier B.V. All rights reserved. APME-318; No. of Pages 2 Please cite this article in press as: Vandana G, Maruti D. Hematocele of the spermatic cord – A case report, Apollo Med. (2015), http://dx.doi. org/10.1016/j.apme.2015.08.003 Available online at www.sciencedirect.com ScienceDirect journal homepage: www.elsevier.com/locate/apme http://dx.doi.org/10.1016/j.apme.2015.08.003 0976-0016/# 2015 Indraprastha Medical Corporation Ltd. Published by Elsevier B.V. All rights reserved.

3. and appendix testis, epididymitis, spermatoinvasion, intras- crotal tumor, and trauma. Unique spermatic cord hematoma has rarely been documented. The etiology may be idiopathic, traumatic, secondary to anticoagulation therapy, or as an extension of a retroperitoneal hemorrhage. It may be misdiagnosed as an incarcerated inguinal hernia, a testicular torsion, or a tumor. When the clinical features mentioned above are present, ultrasonography with Doppler modes should be routinely employed to confirm the diagnosis. Chin1 and Bowman2 reported two cases of the spontaneous idiopathic spermatic cord hematoma suggesting the possible etiologies of spermatic cord vein rupture and tear in the cremasteric muscle. Among traumatic conditions, Gordon et al.3 presented a case of a varicocele ruptured following blunt abdominal trauma with a sudden increase in intra-abdominal pressure with transmission to the varicocele. Hemorrhage secondary to a varicocele, however, is a known but rare morbidity. Spermatic cord hematoma is also a rare complica- tion of Henoch–Schönlein syndrome (HSS).4 So to conclude, spermatic cord hematocele constitutes a very rare case and it could result probably from the lacerations of the spermatic veins and secondary to anticoagulation therapy. Author contribution Gite Vandana, Dhakane Maruti: The acquisition and interpre- tation of data for the work, drafting the work, approval of the version to be published and agree to be accountable for all aspects of the work. Conflicts of interest The authors have none to declare. r e f e r e n c e s 1. Chin W, Cadogan M, Wan R, Harrison L. Spontaneous rupture of varicocele. West Indian Med J. 2009;58(2009):488–489. 2. Bowman J, Anton M. Spermatic cord hematoma in a collegiate football player: a case report. J Athl Train. 1998;33:65–68. 3. Gordon J, Aldoroty R, Stone N. A spermatic cord hematoma secondary to rupture from blunt abdominal trauma: a case report and review. J Urol. 1993;149:602–603. 4. Eyal I, Mizrachi S, Greif Z. Spermatic cord hematoma simulating torsion of testis in Henoch-Schönlein syndrome. Harefuah. 1989;116(5):260–261. Fig. 1 – Gross pathology Fig. 2 – Histopathology. a p o l l o m e d i c i n e x x x ( 2 0 1 5 ) x x x – x x x2 APME-318; No. of Pages 2 Please cite this article in press as: Vandana G, Maruti D. Hematocele of the spermatic cord – A case report, Apollo Med. (2015), http://dx.doi. org/10.1016/j.apme.2015.08.003

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