Post COVID-19 pneumo-hematocele: clinical presentation and treatment pathway.

OBJECTIVES: The appearance of characteristic pulmonary lesions has been noted after COVID-19, being described as post-COVID-19 pneumo-hematocele. The aim of this study is to describe the clinical, histopathologic, and imaging features of pneumo-hematocele and to suggest a treatment algorithm for these patients. METHODS: A retrospective study was performed in patients admitted with a diagnosis of SARS-CoV2 infection from March 2020 to September 2021 who presented a pneumo-hematocele on imaging studies. Clinical and demographic variables were recorded, and CT scans were analyzed. A secondary analysis was performed to estimate the risk provided by the pneumo-hematocele diameter of developing pneumothorax. RESULTS: 37 patients were diagnosed with pneumo-hematoceles, 97.3% were males with a median age of 41 ± 13 years and 51% were smokers. The mean diameter of the pneumatocele was 6.3 ± 2.8 cm; they were more common on the subpleural surface and in the inferior lobe. Thirty patients had ruptured pneumo-hematoceles and developed pneumothorax (81.1%); a total of 26 patients required surgery (70.3%). Lesions measuring 5 cm had a high risk of rupture (OR 6.8, CI 95% 1.1-42); those measuring 3 cm were prone to this complication. For each centimeter that the pneumo-hematocele diameter increases, the OR for rupture increases 1.5. CONCLUSIONS: It appears that post-COVID-19 pneumo-hematocele occurs secondary to encapsulation of blood accumulation inside the lung, as a result of micro-capillary bleeding, with partial reabsorption of blood and subsequent air filling. We recommend surgery for patients with pneumo-hematoceles of 5 cm and those with persistent lesions of 3 cm. TRIAL REGISTRATION: Clinical Trial Registration: NCT05067881.

Adrenal Hemorrhage in Neonates: Unusual Presentation.

Adrenal hemorrhage (AH) is a relatively uncommon condition in newborns. It may be asymptomatic or may present with flank abdominal mass, anemia, jaundice, or rarely as scrotal bruising or hematoma. We report two cases of AH in neonates; the first presented with scrotal hematoma and the second with adrenal mass associated with hypertension and oliguria, primarily secondary to coincidental renal vein thrombosis. Diagnosis was confirmed by abdominal ultrasound. Patients were managed conservatively with clinical observation and by following hemoglobin and bilirubin levels closely. Both infants were discharged without surgical intervention after several days in the hospital. Clinicians should consider AH when a newborn presents with scrotal bruising or hematoma, unexplained anemia, unexplained jaundice, or flank abdominal mass. Timely ultrasonographic evaluation of both adrenal glands and testes in neonates with scrotal hematoma may spare infants from unnecessary surgical intervention because scrotal hematoma often raises the suspicion of testicular torsion.

Occult splenic rupture presenting as acute scrotal swelling.

BACKGROUND: Scrotal pain and swelling is a common complaint encountered in emergency medicine. The differential diagnosis includes testicular, scrotal, and intra-abdominal pathology. CASE REPORT: We present a case of an 80-year-old man on warfarin therapy presenting with acute atraumatic scrotal pain and swelling initially diagnosed as a hydrocele. The diagnosis was subsequently determined to be a communicating hematocele secondary to occult splenic rupture. CONCLUSION: Intra-abdominal pathology can result in scrotal pain and swelling due to passage of intra-abdominal contents into the scrotum via a patent processus vaginalis. Therefore, any cause of hemoperitoneum may also cause hematocele and hematocele should be considered in the differential diagnosis of acute scrotal swelling in any patient with risk factors for bleeding. In these patients, both scrotal and abdominal imaging should be considered.

Hematocele after laparoscopic appendectomy.

BACKGROUND: Laparoscopic appendectomy is one of the most common laparoscopic surgeries performed. We report an unusual complication of hematocele after laparoscopic appendectomy. CASE DESCRIPTION: A 48-y-old male presented with swelling and discomfort in his right scrotum 11 d after he underwent laparoscopic appendectomy for acute appendicitis. Before the surgery, he had no scrotal swelling or inguinal hernia.

Behçet disease presenting with frosted branch angiitis.

The authors present a case of Behçet disease presenting with frosted branch angiitis. Frosted branch angiitis is a rare clinical finding and there are only two reported cases in the literature associated with Behçet disease.

[Chronic hematocele simulating a testicular tumor. Report of two cases]. / Hematocele crónico imitando un tumor testicular. Presentación de dos casos.

OBJECTIVE: Differential diagnosis of a testicular mass includes inflammatory conditions, malignant tumors and traumatic lesions, including hematomas and hematocele. METHODS/RESULTS: We report two cases of chronic hematocele. We discuss the clinico-radiologic characteristic and differential diagnosis. CONCLUSION: Hematocele is difficult to diagnose preoperatively because its symptoms may mimic cysts or neoplasms.

Adenocarcinoma of the rete testis with uncommon presentation as haematocele.

Adenocarcinoma of the rete testis was encountered in a 62-year-old man. The tumour was localised in the region of the testicular hilum as a greyish-white nodule that showed no involvement of the adjacent testicular parenchyma or the epididymis. On microscopical examination, there was a well-differentiated adenocarcinoma separated by fibrovascular stroma, entirely confined to the testicular hilum. This primary carcinoma of the rete testis presented as a haematocele.

Rational approach to diagnosis and management of blunt scrotal trauma.

OBJECTIVES: To provide a rational approach to the diagnosis and management of blunt scrotal trauma to aid clinicians in the selection of patients for surgical exploration. METHODS: We performed a retrospective evaluation of the medical records of 44 patients from two metropolitan tertiary referral hospitals. A total of 29 patients were recruited from July 1, 1993 to June 30, 2003 at one institution and an additional 15 patients from February 1, 1991 to January 31, 1999 at the second. Scrotal ultrasound scans were retrieved and reviewed by a uroradiologist unaware of the treatment regimen and outcome. RESULTS: The presence of both testicular swelling and tenderness suggested more significant testicular injury; however, testicular rupture was present in the absence of tenderness. Three patients with operatively confirmed testicular rupture had only swelling on clinical examination. Five patients with intratesticular hematoma were successfully treated conservatively with interval ultrasound scans recommended to assess for resolution. All patients with operatively confirmed testicular rupture had a combination of the following ultrasound features: the presence of hematocele, disruption of the tunica albuginea, and/or extrusion of the seminiferous tubules. CONCLUSIONS: Patients presenting after blunt scrotal trauma with clinical hematocele should progress directly to exploration. The remainder should undergo scrotal ultrasonography. Those with large hematoceles or suspected rupture on ultrasonography should also proceed to exploration. Those without hematocele, a clearly distinct tunica albuginea, and a lack of fracture planes within the testes are a subgroup that can be successfully treated conservatively.

Two cases of an intrascrotal cystic mass mimicking a testicular tumor and review of the literature.

A 39-year-old man had a 15-year history of an enlarging, firm, nontender mass on the right side of the scrotum after perineal trauma. Right high inguinal orchiectomy was performed, and the histopathological diagnosis was chronic hematocele. A 50-year-old man had a 2-year history of an enlarging, firm, nontender mass on the left side of the scrotum. Left high inguinal orchiectomy was performed. The histopathological diagnosis was a thick membranous hydrocele associated with chronic epididymitis. There were various clinical and histopathological similarities between the two cases. We discuss other intrascrotal cystic masses similar to our cases along with a review of the literature.

Idiopathic chronic hematocele of the vaginal sac

We report a 39-year-old male who presented non-traumatic testicular swelling and pain. Physical examination and sonography presented a suspicion of testicular tumor and both surgical exploration and inguinal orchiectomy were performed. Hematocele may both clinically and sonographically resemble a testicular tumor. The diagnostic study of choice is magnetic resonance, establishing the diagnosis and differentiating it from neoplasms.

Idiopathic chronic hematocele of the vaginal sac.

We report a 39-year-old male who presented non-traumatic testicular swelling and pain. Physical examination and sonography presented a suspicion of testicular tumor and both surgical exploration and inguinal orchiectomy were performed. Hematocele may both clinically and sonographically resemble a testicular tumor. The diagnostic study of choice is magnetic resonance, establishing the diagnosis and differentiating it from neoplasms.

Acute communicating haematocele: unusual presentation after blunt abdominal trauma without solid organ injury.

Haematocele is an unusual scrotal disorder in children, and is generally associated with direct trauma to the inguinoscrotal region. A 6-year-old boy with acute communicating haematocele who had a history of blunt abdominal trauma one week earlier is presented. Interestingly, no solid organ injury was detected on his previous admission for abdominal trauma, nor there was a history of hydrocele.

[Idiopathic superinfected giant hematocele]. / Hematocele gigante sobreinfectado idiopático.

A 45 year old male patient is attended for a marked increase in the size of the left hemiscrotum totally painless. The diagnosis was haematocele, but no cause was found for the bleeding. Orchidectomy and complete exeresis of the tunica vaginalis was carried out.

Communicating hematocele in children following splenic rupture: diagnosis and management.

Acute hematocele is commonly associated with direct testicular trauma. Blood within the tunica vaginalis may infrequently accompany blunt abdominal injury in the presence of a communicating hydrocele. Optimal management involves early recognition and treatment of the abdominal source of bleeding. Elective repair of the communicating hydrocele/hematocele should follow. We report 2 cases of boys with scrotal swelling due to communicating hematoceles. Both cases were associated with a patent processus vaginalis and splenic laceration secondary to blunt trauma.