A 57 y.o. with L hemiparesis complains of scrotal swelling; you notice three masses in the scrotal sac
two of the masses are testicles, the third is shown below.
the L testicle is on the R of the image what is the other mass?
Our patient had a spermatocele. This is a cyst that develops in the epididymis, which may contain sperm and is usually benign. The sperm carrying tubules of the testes lead into the rete testes where efferent ducts lead into the epididymis. These ducts can be blocked by sperm and lead to the formation of a cyst.
Small spermatoceles are common and occur in 30% of men. They can result from epididymitis,, trauma or vasectomy. They are generally painless and must be distinguished from other painless scrotal masses.
spermatoceles arise from the epididymis
OTHER CAUSES OF PAINLESS SCROTAL SWELLING
Testicular cancer- often presents as a painless mass in the scrotum. It has been linked to the use of cannabis. Other risk factors include inguinal hernias, Klinefelter’s syndrome and mumps orchitis. The highest prevalence of testicular cancer is in the US and Europe; it is uncommon in Asia and Africa.
Hematocele- is blood between the parietal and visceral layers of the tunica vaginalis. They can occur after abdominal surgery or trauma.
hematocele after inguinal surgery
Varicoceles- are swellings of the pampiniform plexus, the network of veins supplying the testes. They are acquired due to valvular dysfunction in the veins of the testes and are the most common cause of infertility worldwide.
varicoceles are described as appearing like a “bag of worms”
Metastatic disease- although rare, metastatic disease to the testis is known to occur in leukemia.
Hernias- Most hernias found in the scrotum are indirect hernias passing lateral to the inferior epigastric vessels to enter the the deep inguinal ring.
Hydroceles- are fluid accumulations within the peritoneal cavity of the scrotum. They are most common in newborn males because of the patency of the processus vaginalis but in later life can occur after gonorrhea or local injury.
Our patient was treated as epididymitis, given antibiotics and sent home.
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