Ultrasound Case 068

Presentation

A 76 year old man regularly self catheterizes. His left scrotum has become gradually tender and swollen. The resident is very concerned there is a large solid mass.


View 2: Colour Doppler examination of the testis.
LITFL Top 100 Ultrasound 068 Hydrocele

Describe and interpret these scans

IMAGE INTERPRETATION

Image 1: Longitudinal view sweeping through the left hemiscrotum.

A large hydrocele with several fine loculations surrounds the testis. The testis itself has heterogeneous echotexture and a single microcalcification.

Image 2: Colour Doppler examination of the testis.

There is increased vascularity demonstrated throughout the left testis.


CLINICAL CORRELATION

Orchitis with associated hydrocele

Self catheterisation can cause epidiymitis and orchitis, and orchitis can lead to hydrocele formation. A complex hydrocele with layering and debris can suggest a pyocele.

Very rarely a tension hydrocele can impair testicular vascular supply and drainage allows reperfusion. Orchitis too can rarely result in focal or generalised testicular infarction. In this case there was global increase in vascularity and non-operative management with antibiotics alone was the initial course of action. Follow up ultrasound to ensure resolution was recommended.


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An Emergency physician based in Perth, Western Australia. Professionally my passion lies in integrating advanced diagnostic and procedural ultrasound into clinical assessment and management of the undifferentiated patient. Sharing hard fought knowledge with innovative educational techniques to ensure knowledge translation and dissemination is my goal. Family, wild coastlines, native forests, and tinkering in the shed fills the rest of my contented time. | SonoCPDUltrasound library | Top 100 | @thesonocave |

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