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Skrotal Hematosel ve Hidrosel Ayırımında Ultrasonografik Septasyonun Tanısal Değeri: Tek Merkezli, Retrospektif Bir Çalışma

Year 2024, Volume: 8 Issue: 2, 93 - 98, 30.08.2024
https://doi.org/10.30565/medalanya.1428943

Abstract

Amaç: Skrotum ve testisler yüzeysel organlar olduğundan dolayı palpasyonla ve bazen de transillüminasyonla kolaylıkla incelenebilir. Ancak bu yöntemlerle skrotumdaki sıvının hidrosel mi yoksa hematosel mi olduğunu ayırt etmek mümkün değildir. Bu çalışma, her hekimin tanıyabileceği basit bir bulguya (septasyon) dayanarak hematosel ve hidrosel arasındaki ultrasonografik ayrımı bulmaya çalışmaktadır.

Yöntem: Acil servise (AS) skrotal ağrı, şişlik veya kızarıklık şikayeti ile başvuran hastalar, şikayetleri travmaya bağlı ve şikayetleri spontan olarak gelişenler olmak üzere iki gruba ayrıldı. Çalışmaya dahil edilen tüm hastalara US/ Doppler eğitimini almış bir acil tıp uzmanı tarafından skrotal US/Doppler yapıldı.

Bulgular: Çalışmaya dahil edilen 61 hastanın 36'sı (%59) skrotal travma, 25'i (%41) ise travma dışı şikayetlerle başvurdu. Travma öyküsü olan 36 hastanın 8'inde (%22,2) hematosel, 1'inde (%2,8) hidrosel saptanırken, 27'sinde (%75) ne hematosel ne de hidrosel saptandı. Sekiz hematosel hastasının 6'sında (%75) septasyon saptanırken, 2'sinde (%25) septasyon saptanmadı (p=0,013). Öte yandan; skrotal travma nedeniyle başvuran ve hematosel bulgusu olmayan 28 hastanın hiçbirinde septasyon bulgusu rastlanmadı. Skrotal travma öyküsü olan hastalar, süreye göre gruplandırıldığında, akut veya 1 hafta içinde skrotal travma geçiren 12 hastanın hiçbirinde septasyon bulgusu rastlanmamışken, 1-4 hafta önce travma geçiren 24 hastanın 6’sında (%25) septasyon bulgusu saptanmıştır (p=0.043).

Sonuç: Acil servise skrotal ağrı, şişlik veya ekimoz şikayetiyle başvuran bir hastanın US'de septasyon görüldüğünde öncelikle hematosel dışlanmalıdır. Septasyon varlığı akut travmada hematoselin hidroselden ayrımında yararlı değildir, ancak kronik hematoselin akut hematosel veya hidroselden ayrımında yararlı olabilir.

References

  • 1. Liu, L. Chapter 1 - Applied Anatomy of the Scrotum and Its Contents. In Scrotoscopic Surgery; Yang, J., Ed.; Academic Press, 2019; pp 1–8. https://doi.org/10.1016/B978-0-12-815008-5.00001-7.
  • 2. Kühn AL, Scortegagna E, Nowitzki KM, Kim YH. Ultrasonography of the scrotum in adults. Ultrasonography. 2016;35(3):180-97. doi: 10.14366/usg.15075.
  • 3. Buckley JC, McAninch JW. Use of ultrasonography for the diagnosis of testicular injuries in blunt scrotal trauma. J Urol. 2006;175(1):175-8. doi:10.1016/S0022-5347(05)00048-0.
  • 4. Prajapati DK, Rampal K, Prajapati JM. Review of diagnosis and management of scrotal trauma with a case report. Int J Med Res Prof. 2016;2(3):197-200. doi: 10.21276/ijmrp.2016.2.3.043.
  • 5. Monga M, Hellstrom WJ. Testicular Trauma. Adolesc Med. 1996 Feb;7(1):141-148. PMID: 10359963.
  • 6. Prajapati DK, Rampal K, Prajapati JM. Review of diagnosis and management of scrotal trauma with a case report. Int J Med Res Prof. 2016;2(3):197-200. doi: 10.21276/ijmrp.2016.2.3.043.
  • 7. Lundström KJ, Söderström L, Jernow H, Stattin P, Nordin P. Epidemiology of hydrocele and spermatocele; incidence, treatment and complications. Scand J Urol. 2019 Apr-Jun;53(2-3):134-138. doi: 10.1080/21681805.2019.1600582.
  • 8. Beard JH, Ohene-Yeboah M, devries CR, Schecter WP. Hernia and Hydrocele. In: Debas HT, Donkor P, Gawande A, Jamison DT, Kruk ME, Mock CN, editors. Essential Surgery: Disease Control Priorities, Third Edition (Volume 1). Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2015 Apr 2. Chapter 9. PMID: 26741001.
  • 9. Dagur G, Gandhi J, Suh Y, Weissbart S, Sheynkin YR, Smith NL, Joshi G, Khan SA. Calssifiying Hydroceles of the Pelvis and Groin : An Overview of Etiology Secondary Complications, Evaluation, and Management . Curr Uro. 2017 Apr; 10(1):1-14. Doi: 10.1159/000447145.
  • 10. Velasquez J, Boniface MP, Mohseni M. Acute Scrotum Pain. 2023 May 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 29262236. 11. Bhatt S, Dogra VS. Role of US in testicular and scrotal trauma. Radiographics. 2008;28(6):1617-29. doi: 10.1148/rg.286085507.
  • 12. Tiguert R, Harb JF, Hurley PM, Gomes De Oliveira J, Castillo-Frontera RJ, Triest JA, et al. Management of shotgun injuries to the pelvis and lower genitourinary system. Urology. 2000;55(2):193-7. doi: 10.1016/s0090-4295(99)00384-2.
  • 13. Howe AS, Vasudevan V, Kongnyuy M, Rychik K, Thomas LA, Matuskova M, et al. Degree of twisting and duration of symptoms are prognostic factors of testis salvage during episodes of testicular torsion. Transl Androl Urol. 2017;6(6):1159-66. doi: 10.21037/tau.2017.09.10.
  • 14. Patil V, Shetty SM, Das S. Common and Uncommon Presentation of Fluid within the Scrotal Spaces. Ultrasound Int Open. 2015 Nov;1(2):E34-40. doi: 10.1055/s-0035-1555919.
  • 15. Burgher SW. Acute scrotal pain. Emerg Med Clin North Am. 1998 Nov;16(4):781-809, vi. doi: 10.1016/s0733-8627(05)70033-x.
  • 16. Cunningham JJ. Sonographic findings in clinically unsuspected acute and chronic scrotal hematoceles. AJR Am J Roentgenol. 1983 Apr;140(4):749-52. doi: 10.2214/ajr.140.4.749.
  • 17. Bickle I, El-Feky M, Weerakkody Y. Scrotal hematocele. Radiopaedia.org (Accessed on 18 Jan 2024). doi.org/10.53347/rID-26153.
  • 18. Sood A, Mishra GV, Khandelwal S, Saboo K, Suryadevara M. Post-traumatic Ruptured Scrotal Collection: Pyocele or Hematocele? Cureus. 2023 Sep 13;15(9):e45198. doi: 10.7759/cureus.45198.
  • 19. Symeonidis EN, Sountoulides P, Asouhidou I, Gkekas C, Tsifountoudis I, Tsantila I, Symeonidis A, Georgiadis C, Malioris A, Papathanasiou M. Be cautious of "complex hydrocele" on ultrasound in young men. Arch Ital Urol Androl. 2020 Apr 7;92(1):61-63. doi: 10.4081/aiua.2020.1.61.
  • 20. Ying-Bei Chen, Chapter 244 - Hydrocele, Editor(s): Ming Zhou, George J. Netto, Jonathan I. Epstein, Uropathology (Second Edition), Elsevier, 2023, Pages 541-542, ISBN 9780323653954, https://doi.org/10.1016/B978-0-323-65395-4.00253-0
  • 21. Patil V, Shetty SM, Das S. Common and Uncommon Presentation of Fluid within the Scrotal Spaces. Ultrasound Int Open. 2015 Nov;1(2):E34-40. doi: 10.1055/s-0035-1555919.

Diagnostic Value of Ultrasonographic Septation in the Differentiation of Scrotal Hematocele and Hydrocele: A Single-Center, Retrospective Study

Year 2024, Volume: 8 Issue: 2, 93 - 98, 30.08.2024
https://doi.org/10.30565/medalanya.1428943

Abstract

Aim: Since the scrotum and testicles are superficial organs, they can be easily examined by palpation and sometimes transillumination. However, it is not possible to distinguish whether the fluid in the scrotum is hydrocele or hematocele. This study attempts to find an ultrasonographic distinction between hematocele and hydrocele based on a simple finding (septation) that every physician can recognize.

Methods: Patients who were admitted to the emergency department (ED) with complaints of scrotal pain, swelling or redness were divided into two groups: those whose complaints developed due to trauma and those whose complaints developed spontaneously. All included patients underwent scrotal US/Doppler by an emergency medicine specialist with US training.

Results: Of the 61 patients included in the study, 36 (59%) presented with scrotal trauma and 25 (41%) with non-traumatic complaints. While hematocele was detected in 8 (22.2%) and hydrocele was detected in 1 (2.8%) of 36 patients with a history of trauma, neither hematocele nor hydrocele was detected in 27 (75%). On the other hand, septation was detected in 6 of 8 hematocele patients (75%), but no septation was detected in 2 (25%) patients (p = 0.013). However, no signs of septation were found in any of the 28 patients who presented due to scrotal trauma and had no signs of hematocele. When patients with a history of scrotal trauma were categorized according to duration, no signs of septation were detected in 12 patients who had acute or scrotal trauma within 1 week, while signs of septation were detected in 6 of 24 patients (25%) with a history of scrotal trauma 1-4 weeks ago (p = 0.043).

Conclusion: When septation is seen on the US of a patient who presents to the ED with scrotal pain, swelling, or ecchymosis, hematocele must first be ruled out. The presence of septation is not useful in acute trauma for distinguishing hematocele from hydrocele, but it may be useful in distinguishing chronic hematocele from acute hematocele or hydrocele.

References

  • 1. Liu, L. Chapter 1 - Applied Anatomy of the Scrotum and Its Contents. In Scrotoscopic Surgery; Yang, J., Ed.; Academic Press, 2019; pp 1–8. https://doi.org/10.1016/B978-0-12-815008-5.00001-7.
  • 2. Kühn AL, Scortegagna E, Nowitzki KM, Kim YH. Ultrasonography of the scrotum in adults. Ultrasonography. 2016;35(3):180-97. doi: 10.14366/usg.15075.
  • 3. Buckley JC, McAninch JW. Use of ultrasonography for the diagnosis of testicular injuries in blunt scrotal trauma. J Urol. 2006;175(1):175-8. doi:10.1016/S0022-5347(05)00048-0.
  • 4. Prajapati DK, Rampal K, Prajapati JM. Review of diagnosis and management of scrotal trauma with a case report. Int J Med Res Prof. 2016;2(3):197-200. doi: 10.21276/ijmrp.2016.2.3.043.
  • 5. Monga M, Hellstrom WJ. Testicular Trauma. Adolesc Med. 1996 Feb;7(1):141-148. PMID: 10359963.
  • 6. Prajapati DK, Rampal K, Prajapati JM. Review of diagnosis and management of scrotal trauma with a case report. Int J Med Res Prof. 2016;2(3):197-200. doi: 10.21276/ijmrp.2016.2.3.043.
  • 7. Lundström KJ, Söderström L, Jernow H, Stattin P, Nordin P. Epidemiology of hydrocele and spermatocele; incidence, treatment and complications. Scand J Urol. 2019 Apr-Jun;53(2-3):134-138. doi: 10.1080/21681805.2019.1600582.
  • 8. Beard JH, Ohene-Yeboah M, devries CR, Schecter WP. Hernia and Hydrocele. In: Debas HT, Donkor P, Gawande A, Jamison DT, Kruk ME, Mock CN, editors. Essential Surgery: Disease Control Priorities, Third Edition (Volume 1). Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2015 Apr 2. Chapter 9. PMID: 26741001.
  • 9. Dagur G, Gandhi J, Suh Y, Weissbart S, Sheynkin YR, Smith NL, Joshi G, Khan SA. Calssifiying Hydroceles of the Pelvis and Groin : An Overview of Etiology Secondary Complications, Evaluation, and Management . Curr Uro. 2017 Apr; 10(1):1-14. Doi: 10.1159/000447145.
  • 10. Velasquez J, Boniface MP, Mohseni M. Acute Scrotum Pain. 2023 May 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 29262236. 11. Bhatt S, Dogra VS. Role of US in testicular and scrotal trauma. Radiographics. 2008;28(6):1617-29. doi: 10.1148/rg.286085507.
  • 12. Tiguert R, Harb JF, Hurley PM, Gomes De Oliveira J, Castillo-Frontera RJ, Triest JA, et al. Management of shotgun injuries to the pelvis and lower genitourinary system. Urology. 2000;55(2):193-7. doi: 10.1016/s0090-4295(99)00384-2.
  • 13. Howe AS, Vasudevan V, Kongnyuy M, Rychik K, Thomas LA, Matuskova M, et al. Degree of twisting and duration of symptoms are prognostic factors of testis salvage during episodes of testicular torsion. Transl Androl Urol. 2017;6(6):1159-66. doi: 10.21037/tau.2017.09.10.
  • 14. Patil V, Shetty SM, Das S. Common and Uncommon Presentation of Fluid within the Scrotal Spaces. Ultrasound Int Open. 2015 Nov;1(2):E34-40. doi: 10.1055/s-0035-1555919.
  • 15. Burgher SW. Acute scrotal pain. Emerg Med Clin North Am. 1998 Nov;16(4):781-809, vi. doi: 10.1016/s0733-8627(05)70033-x.
  • 16. Cunningham JJ. Sonographic findings in clinically unsuspected acute and chronic scrotal hematoceles. AJR Am J Roentgenol. 1983 Apr;140(4):749-52. doi: 10.2214/ajr.140.4.749.
  • 17. Bickle I, El-Feky M, Weerakkody Y. Scrotal hematocele. Radiopaedia.org (Accessed on 18 Jan 2024). doi.org/10.53347/rID-26153.
  • 18. Sood A, Mishra GV, Khandelwal S, Saboo K, Suryadevara M. Post-traumatic Ruptured Scrotal Collection: Pyocele or Hematocele? Cureus. 2023 Sep 13;15(9):e45198. doi: 10.7759/cureus.45198.
  • 19. Symeonidis EN, Sountoulides P, Asouhidou I, Gkekas C, Tsifountoudis I, Tsantila I, Symeonidis A, Georgiadis C, Malioris A, Papathanasiou M. Be cautious of "complex hydrocele" on ultrasound in young men. Arch Ital Urol Androl. 2020 Apr 7;92(1):61-63. doi: 10.4081/aiua.2020.1.61.
  • 20. Ying-Bei Chen, Chapter 244 - Hydrocele, Editor(s): Ming Zhou, George J. Netto, Jonathan I. Epstein, Uropathology (Second Edition), Elsevier, 2023, Pages 541-542, ISBN 9780323653954, https://doi.org/10.1016/B978-0-323-65395-4.00253-0
  • 21. Patil V, Shetty SM, Das S. Common and Uncommon Presentation of Fluid within the Scrotal Spaces. Ultrasound Int Open. 2015 Nov;1(2):E34-40. doi: 10.1055/s-0035-1555919.
There are 20 citations in total.

Details

Primary Language English
Subjects Emergency Medicine, Urology
Journal Section Research Article
Authors

Reşad Beyoğlu 0000-0001-7321-5131

Ramazan Serdar Arslan 0000-0002-3139-9531

Murat Seyit 0000-0002-8324-9471

Mert Özen 0000-0001-6653-3756

Publication Date August 30, 2024
Submission Date January 31, 2024
Acceptance Date May 5, 2024
Published in Issue Year 2024 Volume: 8 Issue: 2

Cite

Vancouver Beyoğlu R, Arslan RS, Seyit M, Özen M. Diagnostic Value of Ultrasonographic Septation in the Differentiation of Scrotal Hematocele and Hydrocele: A Single-Center, Retrospective Study. Acta Med. Alanya. 2024;8(2):93-8.

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