A varicocoele mimicking a hydrocoele in a man with portal hypertension: a case report.
Yardy G, Rafique A, Sellers I, Berman L, Bullock N -Journal of medical case reports(2008)
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F3:Colour Doppler ultrasound image – variceal gonadal vein in left inguinal canal.
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Affiliation:Department of Urology, Addenbrooke's Hospital, Cambridge, UK. georgeyardy@doctors.org.uk
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Bottom Line:Surgical repair, if indicated, is generally straightforward.In this patient with misleading clinical signs, diagnosis was established radiologically.Had surgery proceeded without this investigation, significant intra-operative bleeding would have been likely.
Abstract
Introduction: Hydrocoele is a condition frequently encountered in adult urological practice. It is usually of benign aetiology and often diagnosed on clinical grounds. Surgical repair, if indicated, is generally straightforward.
Case presentation: We report a 53-year-old man with liver cirrhosis and clinical features of a hydrocoele, in whom flow was demonstrated using Doppler ultrasonography in the fluid around the testis, which communicated via varices with the left renal vein.
Conclusion: In this patient with misleading clinical signs, diagnosis was established radiologically. Had surgery proceeded without this investigation, significant intra-operative bleeding would have been likely.
Mentions
As the testis was difficult to feel within the fluid collection, a scrotal ultrasound (US) examination was arranged to exclude a testicular tumour as the source of the hydrocoele. This showed no focal lesion within either testis (Figure 1). However, Doppler ultrasonography revealed flow within the fluid surrounding the left testis (Figure 2), communicating via a large scrotal varicocoele with large varices. Figure 3 shows flow demonstrated within these dilated vessels which could be followed through the left inguinal canal (Figure 3) to the region of the left renal vein. Extensive spleno-renal varices were recorded.
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