Presentation
Right hematocele which affected both the surgical anatomy and the postoperative ultrasound appearance.
Patient Data
Preoperative testicular US showing right hydrocele with a small blood clot.
Postoperative testicular US showing thickened sutured tunica vaginalis related to the posterior aspect of the testis (one month postoperative).
Case Discussion
Hematocele is the presence of blood within the tunica vaginalis; conversely testicular hematoma is a blood collection within the testis with or without a ruptured tunica albuginea. Testicular ultrasound provides high sensitive information in testicular assessment 1. Trauma is the main cause of both conditions. In addition, the presence of hydrocele makes the testis more prone to trauma and a hemorrhage into the hydrocele sac may occur 2.
In this case, the patient presented to the outpatient clinic with the clinical picture of the right hydrocele. A preoperative testicular ultrasound confirmed the diagnosis and showed a floating mass in the hydrocele sac. On surgical exploration, there were severe adhesions between the sac and the dartos muscle. Besides, the tunica vaginalis was very thick. On incising the sac, the hydrocele fluid was bloody and there was a blood clot confirming the diagnosis of hematocele. Histopathology confirmed the diagnosis of the blood clot. In addition, neoplasia was excluded.
A Jaboulay procedure was performed in which the sac is everted and sutured at the posterior aspect of the testis. The posterior suture line was more prominent than usual because of the thickened tunica vaginalis. Follow up testicular ultrasound, after one month, was performed mainly to assess the testis. The thickened everted tunica gave this sonographic appearance.
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