Presentation
Scrotal pain and swelling, previous history of herniorrhaphy.
Patient Data
A tortuously zigzagged tubular structure is demonstrated within the left testicular parenchyma which shows a pulsatile flow pattern on spectral Doppler imaging and to and fro color aliasing on color flow Doppler mapping. It measures 2.1 mm in diameter (at the widest portion centrally) with a peak systolic velocity of 28.04 cm/s and an arterial resistive index of 0.75. Small-sized bilateral testicular simple cysts (lined at the mediastinal poles) are noted however, the right testis is visualized within the right distal inguinal canal whereas the left is orthotopic.
The right spermatic cord is edematous and heterogenous compared to the left. Extensive, heterodense, and posteriorly enhancing extra-testicular, medially located scrotal skin focal fluid content (totaling 85.68 cc in volume) is noted. There is moderate left-sided scrotal sac hydrocele (79.4 cc).
Case Discussion
Serpentine, pulsatile left intra-testicular dilated tubular structure consistent with an ectatic tortuous intra-testicular artery. Other noted findings include:
extra-testicular scrotal skin abscess
unilateral right-sided cryptorchidism
left-sided large simple hydrocele
features of bilateral tubular ectasia of the rete testis
small left-sided epididymal appendix (uncomplicated)
Postoperatively, a vertical incision of about 8 cm was made at the most dependable area of the lower scrotum, about 60 cc of pus was drained and non-sharp surgical debridement was done. The right testis was found within the right inguinal canal and fibrosis around the testis though, no intra-testicular exploration was done.