Hematocele

Background

Scrotal anatomy

Scrotal anatomy

• A collection of blood outside of the testicle within the scrotal sac (in the tunica vaginalis)
• Most commonly caused by trauma or surgery

Clinical Features

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).

• Scrotal pain/swelling

Differential Diagnosis

Testicular Diagnoses

• Scrotal cellulitis
• Epididymitis
• Fournier gangrene
• Hematocele
• Hydrocele
  • Hydrocele (peds)
• Indirect inguinal hernia
• Inguinal lymph node (Lymphadenitis)
• Orchitis
• Scrotal abscess
• Spermatocele
• Tinea cruris
• Testicular rupture
• Testicular torsion
• Testicular trauma
• Testicular tumor
• Torsion of testicular appendage
• Varicocele
• Pyocele
• Testicular malignancy
• Scrotal wall hematoma

Evaluation

Scrotal ultrasonography of a hematocele, a couple of weeks after appearance, as a fluid volume with multiple thick septations. The hematocele displays no blood flow on Doppler ultrasonography. A pyocele has a similar appearance, but was excluded by lack of inflammation.

• Scrotal ultrasound with doppler

Management

• Supportive care

Disposition

• If isolated hematocele, likely outpatient follow-up